1162 Military Trail LLC
Optometrist in Orlando, FL. Organization (NPI-2).
NPI number1841572427
StatusActive
Last updated in NPPESSep 9, 2011
Details
- NPI
- 1841572427
- Entity type
- Organization (NPI-2)
- Legal business name
- 1162 Military Trail LLC
- Organization subpart
- No
- Enumeration date
- Sep 9, 2011
- Last updated
- Sep 9, 2011
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 152W00000X | Optometrist | – | – | Yes |
Practice location
7326 Lake Underhill RdOrlando, FL 32822-6055
Phone 407-380-2020
Mailing address
7326 Lake Underhill RdOrlando, FL 32822-6055
Phone 407-380-2020
Authorized official
Stephen Mccormack
Chief Executive Officer
8778810022
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