Healthcare Provider Details

I. General information

NPI: 1467177360
Provider Name (Legal Business Name): ECB EYE FLORIDA CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2022
Last Update Date: 10/04/2022
Certification Date: 10/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 S ORANGE BLOSSOM TRL STE 1560
ORLANDO FL
32809-7654
US

IV. Provider business mailing address

VILLAS DE TINTILLO A14 CALLE A
GUAYNABO PR
00966-1675
US

V. Phone/Fax

Practice location:
  • Phone: 939-644-1781
  • Fax:
Mailing address:
  • Phone: 939-644-1781
  • Fax: 321-352-7419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. CARLOS NEVARES
Title or Position: VICE PRESIDENT
Credential:
Phone: 939-644-1781