Healthcare Provider Details

I. General information

NPI: 1609789494
Provider Name (Legal Business Name): KINGSWAY EYE CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 KINGSWAY RD
BRANDON FL
33510-4601
US

IV. Provider business mailing address

3802A BRITTON PLZ
TAMPA FL
33611-1406
US

V. Phone/Fax

Practice location:
  • Phone: 813-689-2222
  • Fax: 813-689-0802
Mailing address:
  • Phone: 903-503-3187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: SARAH MOI
Title or Position: OPTOMETRIST
Credential: OD
Phone: 903-503-3187