Provider Demographics
NPI:1164935474
Name:ELEVATE YOUR EXISTENCE, LLC
Entity Type:Organization
Organization Name:ELEVATE YOUR EXISTENCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-696-3288
Mailing Address - Street 1:3056 SATILLA LOOP
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-2739
Mailing Address - Country:US
Mailing Address - Phone:954-696-3288
Mailing Address - Fax:
Practice Address - Street 1:8150 CITRUS PARK TOWN CENTER MALL SPC 1100
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-3181
Practice Address - Country:US
Practice Address - Phone:813-920-6824
Practice Address - Fax:813-920-6619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-08
Last Update Date:2021-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4928152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014824000Medicaid