Provider Demographics
NPI:1225457716
Name:PROMENADE EYE CARE, LLC
Entity Type:Organization
Organization Name:PROMENADE EYE CARE, LLC
Other - Org Name:PROMENADE EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANISA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISTOLLARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-975-9181
Mailing Address - Street 1:4413 LYONS RD
Mailing Address - Street 2:SUITE 101 DOCTORS OF OPTOMETRY NEXT TO LENSCRAFTERS
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-4383
Mailing Address - Country:US
Mailing Address - Phone:954-975-9181
Mailing Address - Fax:954-975-9597
Practice Address - Street 1:4413 LYONS RD
Practice Address - Street 2:SUITE 101 DOCTORS OF OPTOMETRY NEXT TO LENSCRAFTERS
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4383
Practice Address - Country:US
Practice Address - Phone:954-975-9181
Practice Address - Fax:954-975-9597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-11
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4633152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty