Provider Demographics
NPI:1104197631
Name:EYE DOCTORS OPTICAL OUTLETS
Entity Type:Organization
Organization Name:EYE DOCTORS OPTICAL OUTLETS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWENSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:813-885-3937
Mailing Address - Street 1:5607 JOHNS RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-4499
Mailing Address - Country:US
Mailing Address - Phone:813-885-3937
Mailing Address - Fax:
Practice Address - Street 1:2670 E STATE ROAD 50 UNIT F
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6038
Practice Address - Country:US
Practice Address - Phone:352-988-2459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-13
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty