Healthcare Provider Details

I. General information

NPI: 1962019471
Provider Name (Legal Business Name): LIZ VAWTER OD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 MANATEE AVE W
BRADENTON FL
34205-5856
US

IV. Provider business mailing address

3811 2ND DR NE
BRADENTON FL
34208-5075
US

V. Phone/Fax

Practice location:
  • Phone: 941-747-1831
  • Fax:
Mailing address:
  • Phone: 941-224-9382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH KATHRYN VAWTER
Title or Position: PRESIDENT
Credential: OD
Phone: 941-224-9382