Provider Demographics
NPI:1073782348
Name:DESCHENEAUX EYECARE LLC
Entity Type:Organization
Organization Name:DESCHENEAUX EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:DESCHENEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:407-365-4040
Mailing Address - Street 1:2984 ALAFAYA TRL
Mailing Address - Street 2:#1030
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-7628
Mailing Address - Country:US
Mailing Address - Phone:407-365-4040
Mailing Address - Fax:
Practice Address - Street 1:2984 ALAFAYA TRL
Practice Address - Street 2:#1030
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-7628
Practice Address - Country:US
Practice Address - Phone:407-365-4040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3108152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty