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General NPI Number Information
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NPI Number | 1093597155
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Entity Type | Organization
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Legal Business Name | HEALING EYE LLC
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Dates
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Enumeration Date | 10/13/2023
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Last Update Date | 10/13/2023
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Provider Practice Location Address
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Address Line | 2020 SEVEN SPRINGS BLVD
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City | NEW PORT RICHEY
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State | FL
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Zip | 34655-3933
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Country | US
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Telephone | 727-372-1311
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 95590
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-0590
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MAVERICK PERICH
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Credential | DO
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Telephone | 727-372-1311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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