Healthcare Provider Details

I. General information

NPI: 1386740884
Provider Name (Legal Business Name): ACCENT EYE CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 05/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 E ASH ST
PERRY FL
32347-2105
US

IV. Provider business mailing address

219 MAGNOLIA RD
PERRY FL
32348-6118
US

V. Phone/Fax

Practice location:
  • Phone: 850-584-2200
  • Fax: 850-584-4412
Mailing address:
  • Phone: 850-223-3402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOP1063
License Number StateFL

VIII. Authorized Official

Name: DR. MICHAEL ANDREW WALBY
Title or Position: OWNER
Credential: OD
Phone: 850-584-2200