Healthcare Provider Details

I. General information

NPI: 1679792451
Provider Name (Legal Business Name): VIVI SHAHIN FRETLAND O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 04/12/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2553 E SILVER SPRINGS BLVD
OCALA FL
34470-7009
US

IV. Provider business mailing address

2553 E SILVER SPRINGS BLVD
OCALA FL
34470-7009
US

V. Phone/Fax

Practice location:
  • Phone: 352-732-6599
  • Fax: 800-611-5078
Mailing address:
  • Phone: 352-732-6599
  • Fax: 800-611-5078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2508
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOP2562
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: