Healthcare Provider Details

I. General information

NPI: 1417625310
Provider Name (Legal Business Name): FREEPORT VISION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2021
Last Update Date: 03/15/2024
Certification Date: 03/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 STATE HIGHWAY 20 E
FREEPORT FL
32439-3900
US

IV. Provider business mailing address

271 STATE HIGHWAY 20 E STE C
FREEPORT FL
32439-3901
US

V. Phone/Fax

Practice location:
  • Phone: 850-880-6778
  • Fax:
Mailing address:
  • Phone: 850-880-6778
  • Fax: 850-200-4373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KATIE GILBERT SPEAR
Title or Position: OWNER
Credential:
Phone: 850-542-5133