Provider Demographics
NPI:1619402963
Name:LARGO FAMILY EYE CARE
Entity Type:Organization
Organization Name:LARGO FAMILY EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:KOREY
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:727-585-8600
Mailing Address - Street 1:10500 ULMERTON RD STE 230
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-3514
Mailing Address - Country:US
Mailing Address - Phone:727-581-3817
Mailing Address - Fax:727-585-4205
Practice Address - Street 1:10500 ULMERTON RD STE 230
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-3514
Practice Address - Country:US
Practice Address - Phone:727-581-3817
Practice Address - Fax:727-585-4205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5078152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1427082478OtherCMS
FL1093197303OtherCMS