Provider Demographics
NPI:1326563362
Name:CAPSTONE EYE CARE GROUP OF FLORIDA LLC
Entity Type:Organization
Organization Name:CAPSTONE EYE CARE GROUP OF FLORIDA LLC
Other - Org Name:PEARLE VISION - S TAMPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTCHER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:727-317-6174
Mailing Address - Street 1:510 E MEMORIAL RD STE A4
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-2218
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3708 HENDERSON BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4504
Practice Address - Country:US
Practice Address - Phone:727-317-6174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAPSTONE EYE CARE GROUP OF FLORIDA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-10
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier