Organization
FORT PIERCE VISION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHILIP C DESANTIS O.D. (MANAGER)
(954) 821-1111
Entity
Organization
Contact information
Practice address
5100 OKEECHOBEE RD, FORT PIERCE, FL 34947-5428
(954) 821-1111
(772) 336-9017
Mailing address
5100 OKEECHOBEE RD, FORT PIERCE, FL 34947-5428
(954) 821-1111
(772) 336-9017
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
OPC2169
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010527400
—
FL
Enumeration date
09/21/2015
Last updated
09/21/2015
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