Healthcare Provider Details

I. General information

NPI: 1770419509
Provider Name (Legal Business Name): GRACE EYECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5991 S GOLDENROD RD
ORLANDO FL
32822-8775
US

IV. Provider business mailing address

5991 S GOLDENROD RD
ORLANDO FL
32822-8775
US

V. Phone/Fax

Practice location:
  • Phone: 407-624-6338
  • Fax:
Mailing address:
  • Phone: 407-624-6338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: YOUNSAUP LEE
Title or Position: OWNER
Credential: OD
Phone: 407-624-6338