Provider Demographics
NPI:1346420353
Name:AFTER-IMAGE EYECARE PA
Entity Type:Organization
Organization Name:AFTER-IMAGE EYECARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:NOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:352-688-1102
Mailing Address - Street 1:2601 FOREST ROAD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606
Mailing Address - Country:US
Mailing Address - Phone:352-688-1102
Mailing Address - Fax:352-688-1103
Practice Address - Street 1:2601 FOREST RD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606
Practice Address - Country:US
Practice Address - Phone:352-688-1102
Practice Address - Fax:352-688-1103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3032152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620262400Medicaid
FL20766OtherBLUE CROSS BLUE SHIELD
FL620262400Medicaid
FL1210800001Medicare NSC
1210800001Medicare NSC
K1436Medicare PIN
FLK1436Medicare PIN
U68450Medicare UPIN