Provider Demographics
NPI:1174160972
Name:CASE VISION ASSOCIATES PA
Entity type:Organization
Organization Name:CASE VISION ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CASE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:386-673-3011
Mailing Address - Street 1:2564 ENTERPRISE RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-7904
Mailing Address - Country:US
Mailing Address - Phone:386-774-7242
Mailing Address - Fax:386-774-8442
Practice Address - Street 1:1474 W GRANADA BLVD STE 470
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8240
Practice Address - Country:US
Practice Address - Phone:386-673-3011
Practice Address - Fax:386-673-3099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-30
Last Update Date:2019-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty