Healthcare Provider Details

I. General information

NPI: 1124520481
Provider Name (Legal Business Name): 20/20 EYE CARE ON CURRY FORD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2018
Last Update Date: 03/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4507 CURRY FORD RD
ORLANDO FL
32812-2710
US

IV. Provider business mailing address

4507 CURRY FORD RD
ORLANDO FL
32812-2710
US

V. Phone/Fax

Practice location:
  • Phone: 407-277-2020
  • Fax:
Mailing address:
  • Phone: 407-277-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC5035
License Number StateFL

VIII. Authorized Official

Name: DR. PAMELA J BLADE
Title or Position: OD
Credential: OD
Phone: 407-277-2020