Healthcare Provider Details

I. General information

NPI: 1396205779
Provider Name (Legal Business Name): CENTRAL FLORIDA HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 03/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 INGRAHAM AVE
HAINES CITY FL
33844-4327
US

IV. Provider business mailing address

47 5TH ST NW
WINTER HAVEN FL
33881-4672
US

V. Phone/Fax

Practice location:
  • Phone: 863-438-6900
  • Fax:
Mailing address:
  • Phone: 863-268-7850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TAMARA TREADWAY
Title or Position: MANAGED CARE SUPERVISOR / CREDENTIA
Credential:
Phone: 863-268-7850