Healthcare Provider Details

I. General information

NPI: 1083898928
Provider Name (Legal Business Name): KAY T VIEN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 03/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4413 HOFFNER AVE
BELLE ISLE FL
32812-2331
US

IV. Provider business mailing address

4413 HOFFNER AVE
BELLE ISLE FL
32812-2331
US

V. Phone/Fax

Practice location:
  • Phone: 407-207-5310
  • Fax:
Mailing address:
  • Phone: 407-207-5310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC4260
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: