Provider Demographics
NPI:1760449623
Name:SINCLAIR & CAMP, OD, PA
Entity Type:Organization
Organization Name:SINCLAIR & CAMP, OD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMP
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:941-366-2892
Mailing Address - Street 1:615 S ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-7503
Mailing Address - Country:US
Mailing Address - Phone:941-366-2892
Mailing Address - Fax:941-366-2893
Practice Address - Street 1:615 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-7503
Practice Address - Country:US
Practice Address - Phone:941-366-2892
Practice Address - Fax:941-366-2893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP02495152W00000X, 152WC0802X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620040100Medicaid
FLCC5937Medicare PIN
FL620040100Medicaid
FL0758320001Medicare NSC