Healthcare Provider Details

I. General information

NPI: 1831376953
Provider Name (Legal Business Name): MAITLAND VISION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S ORLANDO AVE SUITE 300
MAITLAND FL
32751-5660
US

IV. Provider business mailing address

600 S ORLANDO AVE SUITE 300
MAITLAND FL
32751-5660
US

V. Phone/Fax

Practice location:
  • Phone: 407-647-2020
  • Fax:
Mailing address:
  • Phone: 407-647-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MARY WILLSON YEILDING
Title or Position: PARTNER
Credential: O.D.
Phone: 407-647-2020