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NPI Code Detail

MEDICARE: ST. CLOUD EYE CARE

MEDICARE: ST. CLOUD EYE CARE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristOPC4211FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093035032
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST. CLOUD EYE CARE
Provider Business Mailing Address
First Line : 2050 OLD HICKORY TREE RD
Second Line : SUITE I
City : SAINT CLOUD
State : FL
Zip : 34772-8926
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2050 OLD HICKORY TREE RD
Second Line : SUITE I
City : SAINT CLOUD
State : FL
Zip : 34772-8926
Country : US
Telephone Number : 407-556-3969
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. COLLEEN BUI
Credential :
Telephone Number : 407-556-3969
Provider Enumeration Date : 06/01/2010
Last Update Date : 06/01/2010

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Directions to “ST. CLOUD EYE CARE ” Practice Location

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