Healthcare Provider Details

I. General information

NPI: 1194591586
Provider Name (Legal Business Name): KRISHSAYI MATHANARUBAN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2023
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9428 W COLONIAL DR
OCOEE FL
34761-6800
US

IV. Provider business mailing address

5607 JOHNS RD
TAMPA FL
33634-4499
US

V. Phone/Fax

Practice location:
  • Phone: 407-291-1921
  • Fax:
Mailing address:
  • Phone: 813-885-3937
  • Fax: 813-880-8375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC6374
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: