Provider Demographics
NPI:1871620690
Name:VISIONARY EYECARE ASSOCIATES, INC.
Entity type:Organization
Organization Name:VISIONARY EYECARE ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-851-9949
Mailing Address - Street 1:9910 PINES BLVD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6139
Mailing Address - Country:US
Mailing Address - Phone:954-851-9949
Mailing Address - Fax:
Practice Address - Street 1:12801 W SUNRISE BLVD
Practice Address - Street 2:#931
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-4020
Practice Address - Country:US
Practice Address - Phone:954-851-9949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2885152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOP0626OtherEYEMED PROVIDER NUMBER