Provider Demographics
NPI:1184904260
Name:411 EYES, LLC.
Entity type:Organization
Organization Name:411 EYES, LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:UCCI
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC NCLE
Authorized Official - Phone:407-767-5600
Mailing Address - Street 1:1270 SAXON BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8418
Mailing Address - Country:US
Mailing Address - Phone:386-774-5000
Mailing Address - Fax:386-774-0444
Practice Address - Street 1:1270 SAXON BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8418
Practice Address - Country:US
Practice Address - Phone:386-774-5000
Practice Address - Fax:386-774-0444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-22
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2732152W00000X
FLDO 5119332H00000X
FLOE 2002332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty