Provider Demographics
NPI:1407008105
Name:EYES & OPTICS, PL
Entity Type:Organization
Organization Name:EYES & OPTICS, PL
Other - Org Name:EYES & OPTICS
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:J
Authorized Official - Last Name:MACKINDER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:407-644-5156
Mailing Address - Street 1:312 N PARK AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-3305
Mailing Address - Country:US
Mailing Address - Phone:407-644-5156
Mailing Address - Fax:407-644-5290
Practice Address - Street 1:312 N PARK AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-3305
Practice Address - Country:US
Practice Address - Phone:407-644-5156
Practice Address - Fax:407-644-5290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC003140152W00000X
FLOPC003232152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1730171174OtherNPI
FL1902954092OtherNPI
FLU68491Medicare UPIN
FLE0073ZMedicare PIN