Healthcare Provider Details

I. General information

NPI: 1235228669
Provider Name (Legal Business Name): EYE EXPRESS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 01/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 N. BROADWAY
BARTOW FL
33830-3343
US

IV. Provider business mailing address

215 1ST ST N
WINTER HAVEN FL
33881-4537
US

V. Phone/Fax

Practice location:
  • Phone: 863-534-2020
  • Fax: 863-534-3674
Mailing address:
  • Phone: 863-299-8908
  • Fax: 863-299-1061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC931
License Number StateFL

VIII. Authorized Official

Name: DR. STEPHEN F. PHILLIPS
Title or Position: OWNER
Credential: OD
Phone: 863-299-8908