Organization
MAC UNLIMITED LLC
Active
Other names
Mobile Vision Source
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL ANTHONY CUSUMANO O.D. (PRESIDENT)
(813) 300-7839
Entity
Organization
Contact information
Practice address
178 E DAVIS BLVD, TAMPA, FL 33606-3514
(813) 300-7839
(813) 425-9342
Mailing address
178 E DAVIS BLVD, TAMPA, FL 33606-3514
(813) 300-7839
(813) 425-9342
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
OPC2471
FL
310400000X
Assisted Living Facility
Primary
OPC2471
FL
314000000X
Skilled Nursing Facility
OPC2471
FL
315D00000X
Inpatient Hospice
OPC2471
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AC608
PROVIDER TRASACTION ACCES
FL
Enumeration date
05/08/2007
Last updated
11/16/2015
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