Provider Demographics
NPI:1982101572
Name:OPTICARE MEDICINE, PLLC
Entity Type:Organization
Organization Name:OPTICARE MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINES MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAMALA
Authorized Official - Middle Name:MARION
Authorized Official - Last Name:ROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-409-3680
Mailing Address - Street 1:PO BOX3349
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-3349
Mailing Address - Country:US
Mailing Address - Phone:352-409-3680
Mailing Address - Fax:352-483-7499
Practice Address - Street 1:9400 TURKEY LAKE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8001
Practice Address - Country:US
Practice Address - Phone:352-409-3680
Practice Address - Fax:352-483-7499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13607207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty