Healthcare Provider Details

I. General information

NPI: 1487845707
Provider Name (Legal Business Name): EYE DOCTORS OPTICAL OUTLETS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 E FOWLER AVE
TAMPA FL
33612-5416
US

IV. Provider business mailing address

5607 JOHNS RD
TAMPA FL
33634-4317
US

V. Phone/Fax

Practice location:
  • Phone: 813-971-0471
  • Fax:
Mailing address:
  • Phone: 813-885-3937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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