Healthcare Provider Details

I. General information

NPI: 1346075959
Provider Name (Legal Business Name): SECOND OPTOMETRIC CARE OF FLORIDA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 JOHN SIMS PKWY E
NICEVILLE FL
32578-2752
US

IV. Provider business mailing address

3333 QUALITY DR
RANCHO CORDOVA CA
95670-7985
US

V. Phone/Fax

Practice location:
  • Phone: 850-279-4361
  • Fax:
Mailing address:
  • Phone: 916-851-6611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRITTANY HARRISON
Title or Position: DIRECTOR
Credential:
Phone: 850-279-4361