Healthcare Provider Details

I. General information

NPI: 1538231626
Provider Name (Legal Business Name): MISSBA BAWANEY O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8990 TURKEY LAKE ROAD MB EYECARE, LLC
ORLANDO FL
32819
US

IV. Provider business mailing address

MB EYECARE, LLC 8990 TURKEY LAKE ROAD
ORLANDO FL
32819
US

V. Phone/Fax

Practice location:
  • Phone: 847-677-7202
  • Fax: 847-677-1258
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number46009886
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046009886
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC4197
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: