Healthcare Provider Details

I. General information

NPI: 1437617644
Provider Name (Legal Business Name): EYE DOCTORS OPTICAL OUTLETS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2019
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4945 GOLDEN GATE PKWY STE 110
NAPLES FL
34116-6973
US

IV. Provider business mailing address

5607 JOHNS RD
TAMPA FL
33634-4499
US

V. Phone/Fax

Practice location:
  • Phone: 239-214-3789
  • Fax:
Mailing address:
  • Phone: 813-885-3937
  • 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. ROBERT C. COPPOLA
Title or Position: PRESIDENT
Credential: OD
Phone: 954-917-2337