Provider Demographics
NPI:1114461746
Name:EYE DOCTORS OPTICAL OUTLETS PA
Entity Type:Organization
Organization Name:EYE DOCTORS OPTICAL OUTLETS PA
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 1:6844 GALL BLVD
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-2512
Mailing Address - Country:US
Mailing Address - Phone:813-603-3479
Mailing Address - Fax:813-333-7990
Practice Address - Street 1:6844 GALL BLVD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-2512
Practice Address - Country:US
Practice Address - Phone:813-603-3479
Practice Address - Fax:813-333-7990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-16
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty