Provider Demographics
NPI:1932424496
Name:TUCKER EYE-EXAM & CONTACT LENS CENTER
Entity Type:Organization
Organization Name:TUCKER EYE-EXAM & CONTACT LENS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIANN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:352-361-5205
Mailing Address - Street 1:3955 HUNTERS RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-1855
Mailing Address - Country:US
Mailing Address - Phone:352-361-5202
Mailing Address - Fax:800-878-9609
Practice Address - Street 1:12950 E COLONIAL DR
Practice Address - Street 2:SUITE # 100
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-4609
Practice Address - Country:US
Practice Address - Phone:352-361-5205
Practice Address - Fax:800-878-9609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-28
Last Update Date:2010-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL OPC #1977152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19281Medicare PIN