Healthcare Provider Details

I. General information

NPI: 1467908228
Provider Name (Legal Business Name): CENTRAL FLORIDA OPTICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 N ORANGE AVE
ORLANDO FL
32804-5531
US

IV. Provider business mailing address

1900 N ORANGE AVE
ORLANDO FL
32804-5531
US

V. Phone/Fax

Practice location:
  • Phone: 407-896-8990
  • Fax: 407-896-6034
Mailing address:
  • Phone: 407-896-8990
  • Fax: 407-896-6034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FC0801X
TaxonomyContact Lens Fitter
License NumberDO6032
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberDO6032
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberDO6032
License Number StateFL

VIII. Authorized Official

Name: MR. WESLEY D STUART
Title or Position: LICENSED OPTICIAN
Credential: LDO
Phone: 407-896-8990