Provider Demographics
NPI:1104201920
Name:HEALTHY EYES CENTER LLC
Entity Type:Organization
Organization Name:HEALTHY EYES CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:813-231-8509
Mailing Address - Street 1:1720 E HILLSBOROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-8234
Mailing Address - Country:US
Mailing Address - Phone:813-231-8509
Mailing Address - Fax:813-231-7302
Practice Address - Street 1:1720 E HILLSBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-8234
Practice Address - Country:US
Practice Address - Phone:813-231-8509
Practice Address - Fax:813-231-7302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4991152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty