Provider Demographics
NPI:1700979424
Name:PASTORE-TRAN EYECARE, INC.
Entity type:Organization
Organization Name:PASTORE-TRAN EYECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:321-639-2020
Mailing Address - Street 1:P.O. BOX 560580
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32956-0580
Mailing Address - Country:US
Mailing Address - Phone:321-693-4124
Mailing Address - Fax:
Practice Address - Street 1:1285 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2711
Practice Address - Country:US
Practice Address - Phone:321-639-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2018-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3723152W00000X
FLOPC3769152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003516800Medicaid
FL003516800Medicaid
FLU2800AMedicare PIN
FLV00419Medicare UPIN