Provider Demographics
NPI:1952093460
Name:ONTARGET EYECARE LLC
Entity Type:Organization
Organization Name:ONTARGET EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAMARIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BENITEZ-KREYMBORG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:786-253-5922
Mailing Address - Street 1:15 LLOVERA PL
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-5868
Mailing Address - Country:US
Mailing Address - Phone:786-253-5922
Mailing Address - Fax:
Practice Address - Street 1:5100 STATE RTE 100
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164
Practice Address - Country:US
Practice Address - Phone:386-586-7924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty