Provider Demographics
NPI:1396498184
Name:OPTIMAL EYECARE, LLC
Entity type:Organization
Organization Name:OPTIMAL EYECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:AVI
Authorized Official - Last Name:CASE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:941-421-2684
Mailing Address - Street 1:1211 46TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-4411
Mailing Address - Country:US
Mailing Address - Phone:614-284-3791
Mailing Address - Fax:
Practice Address - Street 1:2001 E FOWLER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-5500
Practice Address - Country:US
Practice Address - Phone:813-972-5728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014768600Medicaid
FL104525200Medicaid