Healthcare Provider Details

I. General information

NPI: 1215358833
Provider Name (Legal Business Name): EYE DOCTORS OPTICAL OUTLETS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2013
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6927 4TH ST N
ST PETERSBURG FL
33702-6846
US

IV. Provider business mailing address

5607 JOHNS RD
TAMPA FL
33634-4499
US

V. Phone/Fax

Practice location:
  • Phone: 727-214-2594
  • Fax: 727-210-8672
Mailing address:
  • Phone: 813-885-3937
  • Fax: 813-880-8375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ROBERT C. COPPOLA
Title or Position: PRESIDENT
Credential: OD
Phone: 954-917-2337