Healthcare Provider Details

I. General information

NPI: 1578274031
Provider Name (Legal Business Name): EYECONIC EYE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 LIGHTHOUSE DR
BRADENTON FL
34212-2168
US

IV. Provider business mailing address

805 LIGHTHOUSE DR
BRADENTON FL
34212-2168
US

V. Phone/Fax

Practice location:
  • Phone: 941-213-0762
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. NATHAN JOSEPH CLIMO
Title or Position: OPTOMETRIST
Credential: OD
Phone: 941-213-0762