# RADIANT VISION EYECARE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568170827
- **Authorized official:** MARISSA NICOTRA O.D. (OWNER)
- **Authorized official phone:** (386) 200-4501

## Contact information

- **Practice address:** 5517 S WILLIAMSON BLVD STE 310, PORT ORANGE, FL 32128-8310
- **Practice address phone:** (386) 200-4501
- **Mailing address:** 1500 BEVILLE RD, SUITE 606, MAILBOX 369, DAYTONA BEACH, FL 32114

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | — | NULL | Yes |
| 152W00000X | Optometrist | — | — | Yes |

## Other

- **Enumeration date:** 11/07/2022
- **Last updated:** 11/07/2022