Provider Demographics
NPI:1558864272
Name:SPECIALTY VISION CARE LLC
Entity type:Organization
Organization Name:SPECIALTY VISION CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAILESH
Authorized Official - Middle Name:K
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-322-3588
Mailing Address - Street 1:2001 W SAMPLE RD STE 318
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-1342
Mailing Address - Country:US
Mailing Address - Phone:561-463-3151
Mailing Address - Fax:
Practice Address - Street 1:2001 W SAMPLE RD STE 320
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-1346
Practice Address - Country:US
Practice Address - Phone:561-226-4922
Practice Address - Fax:561-292-0922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-09
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty