Provider Demographics
NPI:1356664106
Name:TRINITY EYE ASSOCIATES LLC
Entity Type:Organization
Organization Name:TRINITY EYE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JILMA
Authorized Official - Middle Name:H
Authorized Official - Last Name:ELLISON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:407-810-2790
Mailing Address - Street 1:3607 ALOMA AVE STE 1081
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-8811
Mailing Address - Country:US
Mailing Address - Phone:407-678-9151
Mailing Address - Fax:
Practice Address - Street 1:3607 ALOMA AVE STE 1081
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-8811
Practice Address - Country:US
Practice Address - Phone:407-678-9151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-08
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4126261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center