Healthcare Provider Details

I. General information

NPI: 1386159358
Provider Name (Legal Business Name): CAPSTONE EYE CARE GROUP OF FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2017
Last Update Date: 12/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S ORLANDO AVE STE 11
WINTER PARK FL
32789-3656
US

IV. Provider business mailing address

510 E MEMORIAL RD STE A4
OKLAHOMA CITY OK
73114-2218
US

V. Phone/Fax

Practice location:
  • Phone: 407-571-9165
  • Fax:
Mailing address:
  • Phone: 310-868-7322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: JEFF BUTCHER
Title or Position: OWNER
Credential: OD
Phone: 405-317-2140