Provider Demographics
NPI:1336575554
Name:VIP EYE CARE AND EYE WEAR INC
Entity Type:Organization
Organization Name:VIP EYE CARE AND EYE WEAR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MONA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HENRI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:727-894-0500
Mailing Address - Street 1:2201 4TH ST N STE A
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-4300
Mailing Address - Country:US
Mailing Address - Phone:727-894-0500
Mailing Address - Fax:727-823-8697
Practice Address - Street 1:2201 4TH ST N STE A
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-4300
Practice Address - Country:US
Practice Address - Phone:727-894-0500
Practice Address - Fax:727-823-8697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-19
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC0002526152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078852000Medicaid
FL2043UMedicare PIN
FL078852000Medicaid