Provider Demographics
NPI:1366624769
Name:CELEBRATION EYE CARE
Entity Type:Organization
Organization Name:CELEBRATION EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:407-460-0516
Mailing Address - Street 1:741 FRONT ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-4991
Mailing Address - Country:US
Mailing Address - Phone:407-566-2020
Mailing Address - Fax:
Practice Address - Street 1:741 FRONT ST
Practice Address - Street 2:SUITE 120
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-4991
Practice Address - Country:US
Practice Address - Phone:407-566-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1995, OPC 2049152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0789241-00Medicaid
FL0789241-00Medicaid