Provider Demographics
NPI:1629596200
Name:OPTIX
Entity Type:Organization
Organization Name:OPTIX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:JISELLE
Authorized Official - Last Name:BLADE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:407-217-7375
Mailing Address - Street 1:9001 TABORFIELD AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836-8905
Mailing Address - Country:US
Mailing Address - Phone:407-217-7375
Mailing Address - Fax:
Practice Address - Street 1:9001 TABORFIELD AVE STE 101
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32836-8905
Practice Address - Country:US
Practice Address - Phone:407-217-7375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-05
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5035152W00000X, 152WS0006X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Single Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty