Healthcare Provider Details

I. General information

NPI: 1275724213
Provider Name (Legal Business Name): EYE DOCTORS OPTICAL OUTLETS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 W SAND LAKE RD SUITE D118
ORLANDO FL
32809-9149
US

IV. Provider business mailing address

5607 JOHNS RD
TAMPA FL
33634-4317
US

V. Phone/Fax

Practice location:
  • Phone: 407-351-5745
  • 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