Provider Demographics
NPI:1053457291
Name:CITRUS PARK EYECARE INC
Entity Type:Organization
Organization Name:CITRUS PARK EYECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:HELSING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:813-792-0700
Mailing Address - Street 1:7865 GUNN HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1611
Mailing Address - Country:US
Mailing Address - Phone:813-792-0700
Mailing Address - Fax:813-792-0750
Practice Address - Street 1:7865 GUNN HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1611
Practice Address - Country:US
Practice Address - Phone:813-792-0700
Practice Address - Fax:813-792-0750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOB3301152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5827290001Medicare NSC
FL19444ZMedicare PIN
FLU79777Medicare UPIN