Healthcare Provider Details

I. General information

NPI: 1720795933
Provider Name (Legal Business Name): STREETER VISION PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2022
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 S FERDON BLVD
CRESTVIEW FL
32536-4507
US

IV. Provider business mailing address

100 SWIFT CREEK CT
NICEVILLE FL
32578-3710
US

V. Phone/Fax

Practice location:
  • Phone: 850-331-3918
  • Fax:
Mailing address:
  • Phone: 850-758-5981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: THOMAS ALLEN STREETER
Title or Position: OWNER
Credential: OD
Phone: 850-758-5981