Healthcare Provider Details

I. General information

NPI: 1740193127
Provider Name (Legal Business Name): ELOHIM VISION PROVIDER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 W TENNESSEE ST
TALLAHASSEE FL
32304-1029
US

IV. Provider business mailing address

1216 LANDINGS LOOP
TALLAHASSEE FL
32311-1230
US

V. Phone/Fax

Practice location:
  • Phone: 850-509-9234
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. ALBERTO SANCHEZ
Title or Position: OPTOMETRIST
Credential: OD
Phone: 850-509-9234