Provider Demographics
NPI:1588487458
Name:VISION DOCTORS GROUP, LLC
Entity type:Organization
Organization Name:VISION DOCTORS GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:VERXAGIO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-439-2015
Mailing Address - Street 1:1315 SILK OAK DR
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-1367
Mailing Address - Country:US
Mailing Address - Phone:305-439-2015
Mailing Address - Fax:
Practice Address - Street 1:2734 TREASURE COVE CIR
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-5605
Practice Address - Country:US
Practice Address - Phone:305-439-2015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty