Healthcare Provider Details

I. General information

NPI: 1265774178
Provider Name (Legal Business Name): EYE EXPRESS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 12/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3140 CITRUS TOWER BLVD BLDG 11
CLERMONT FL
34711-6888
US

IV. Provider business mailing address

215 1ST ST N STE. 100
WINTER HAVEN FL
33881-4537
US

V. Phone/Fax

Practice location:
  • Phone: 863-875-6568
  • Fax: 863-299-1061
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 Number
License Number State

VIII. Authorized Official

Name: BRAD SALOMON
Title or Position: PRESIDENT
Credential: OD
Phone: 863-875-6568