Provider Demographics
NPI:1063701977
Name:NEW VISION SURGICAL CENTER, LLC
Entity type:Organization
Organization Name:NEW VISION SURGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:MINOTTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-257-8700
Mailing Address - Street 1:1055 37TH PL
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6551
Mailing Address - Country:US
Mailing Address - Phone:772-257-8700
Mailing Address - Fax:772-257-8715
Practice Address - Street 1:1055 37TH PL
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6551
Practice Address - Country:US
Practice Address - Phone:772-257-8700
Practice Address - Fax:772-257-8715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-31
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1345261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10C0001563OtherMEDICARE ASC IDENTIFICATION NUMBER