Healthcare Provider Details

I. General information

NPI: 1679865596
Provider Name (Legal Business Name): EYEMAX VISION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 05/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2146 VINDALE RD
TAVARES FL
32778-5602
US

IV. Provider business mailing address

316 SE 12TH ST STE 200
OCALA FL
34471-3774
US

V. Phone/Fax

Practice location:
  • Phone: 352-401-1919
  • Fax: 352-401-3539
Mailing address:
  • Phone: 352-401-1919
  • Fax: 352-401-3539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. VISHNU PATLOLA REDDY
Title or Position: OWNER
Credential: M.D.
Phone: 352-401-1919