Provider Demographics
NPI:1720652316
Name:THE VISION HUB LLC
Entity type:Organization
Organization Name:THE VISION HUB LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCERETO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-542-5133
Mailing Address - Street 1:770 US HIGHWAY 331 S STE 1
Mailing Address - Street 2:
Mailing Address - City:DEFUNIAK SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32435-3307
Mailing Address - Country:US
Mailing Address - Phone:850-892-5514
Mailing Address - Fax:850-200-4373
Practice Address - Street 1:770 US HIGHWAY 331 S STE 1
Practice Address - Street 2:
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32435-3307
Practice Address - Country:US
Practice Address - Phone:850-892-5514
Practice Address - Fax:850-892-0189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-18
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111200300Medicaid
XB20DOtherBCBS