Provider Demographics
NPI:1982792073
Name:OVIEDO VISION CENTER PA
Entity Type:Organization
Organization Name:OVIEDO VISION CENTER PA
Other - Org Name:GARY D MCDONALD OD PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:PHUNG
Authorized Official - Middle Name:M
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:407-366-7655
Mailing Address - Street 1:875 CLARK STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765
Mailing Address - Country:US
Mailing Address - Phone:407-366-7655
Mailing Address - Fax:407-366-4129
Practice Address - Street 1:875 CLARK ST
Practice Address - Street 2:SUITE A
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-2900
Practice Address - Country:US
Practice Address - Phone:407-366-7655
Practice Address - Fax:407-366-4129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106705100Medicaid