Provider Demographics
NPI:1649609363
Name:RAWLS, VICTORIA TRIEU
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:TRIEU
Last Name:RAWLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5215 SE ABSHIER BLVD
Mailing Address - Street 2:
Mailing Address - City:BELLEVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:34420-3916
Mailing Address - Country:US
Mailing Address - Phone:352-347-6008
Mailing Address - Fax:
Practice Address - Street 1:5215 SE ABSHIER BLVD
Practice Address - Street 2:
Practice Address - City:BELLEVIEW
Practice Address - State:FL
Practice Address - Zip Code:34420-3916
Practice Address - Country:US
Practice Address - Phone:352-347-6008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4835152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist