Provider Demographics
NPI:1154124642
Name:VISION SOURCE MAITLAND, LLC
Entity type:Organization
Organization Name:VISION SOURCE MAITLAND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:N
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:407-971-1001
Mailing Address - Street 1:1305 TREE SWALLOW DR
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-6634
Mailing Address - Country:US
Mailing Address - Phone:407-971-1001
Mailing Address - Fax:407-971-1002
Practice Address - Street 1:1020 LOCKWOOD BLVD
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6027
Practice Address - Country:US
Practice Address - Phone:407-971-1001
Practice Address - Fax:407-971-1002
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VISION SOURCE MAITLAND, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty