Provider Demographics
NPI:1679865596
Name:EYEMAX VISION CENTER, LLC
Entity Type:Organization
Organization Name:EYEMAX VISION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VISHNU
Authorized Official - Middle Name:PATLOLA
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-401-1919
Mailing Address - Street 1:316 SE 12TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-3774
Mailing Address - Country:US
Mailing Address - Phone:352-401-1919
Mailing Address - Fax:352-401-3539
Practice Address - Street 1:2146 VINDALE RD
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-5602
Practice Address - Country:US
Practice Address - Phone:352-401-1919
Practice Address - Fax:352-401-3539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty