Healthcare Provider Details

I. General information

NPI: 1184393720
Provider Name (Legal Business Name): TRUE EYE EXPERTS WEST PALM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 01/07/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

634 21ST ST
VERO BEACH FL
32960-0933
US

IV. Provider business mailing address

19070 BRUCE B DOWNS BLVD
TAMPA FL
33647-2477
US

V. Phone/Fax

Practice location:
  • Phone: 772-567-6513
  • Fax: 813-631-9802
Mailing address:
  • Phone: 813-632-2020
  • Fax: 813-631-9802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LYNN BASHLINE
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 727-642-9100