Healthcare Provider Details

I. General information

NPI: 1255532677
Provider Name (Legal Business Name): PVCP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8633 CITRUS PARK DR
TAMPA FL
33625-3014
US

IV. Provider business mailing address

8633 CITRUS PARK DR
TAMPA FL
33625-3014
US

V. Phone/Fax

Practice location:
  • Phone: 813-920-3150
  • Fax: 813-920-3305
Mailing address:
  • Phone: 813-920-3150
  • Fax: 813-920-3305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number1526
License Number StateFL

VIII. Authorized Official

Name: MR. FRANK D PLUMB
Title or Position: OWNER
Credential: OPTICIAN
Phone: 813-920-3150