Provider Demographics
NPI:1780854281
Name:VISIONARY EYE CARE TAMPA INC
Entity Type:Organization
Organization Name:VISIONARY EYE CARE TAMPA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:BRADY
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:813-425-9596
Mailing Address - Street 1:17655 NORTH DALE MABRY HWY
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33548-4535
Mailing Address - Country:US
Mailing Address - Phone:813-425-9596
Mailing Address - Fax:
Practice Address - Street 1:3015 SAMARA DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-4305
Practice Address - Country:US
Practice Address - Phone:813-334-0555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3566152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty