Provider Demographics
NPI:1194597690
Name:VISION SOURCE MAITLAND, LLC
Entity type:Organization
Organization Name:VISION SOURCE MAITLAND, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
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:407-462-3738
Mailing Address - Street 1:238 S ORLANDO AVE
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5604
Mailing Address - Country:US
Mailing Address - Phone:407-971-1001
Mailing Address - Fax:407-971-1002
Practice Address - Street 1:238 S ORLANDO AVE
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751
Practice Address - Country:US
Practice Address - Phone:407-971-1001
Practice Address - Fax:407-971-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-27
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty