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General NPI Number Information
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NPI Number | 1164192753
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Entity Type | Organization
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Legal Business Name | EYES OF TEQUESTA, PLLC
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Dates
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Enumeration Date | 09/15/2021
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Last Update Date | 09/15/2021
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Provider Practice Location Address
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Address Line | 596 N US HIGHWAY 1
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City | TEQUESTA
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State | FL
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Zip | 33469-2373
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Country | US
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Telephone | 561-581-2020
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Fax | 561-581-2007
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Provider Business Mailing Address
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Address Line | 9366 SE RIVER TER
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City | TEQUESTA
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State | FL
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Zip | 33469-1336
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Country | US
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Telephone | 407-394-4294
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. MARILU GREYLING FORD
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Credential | OD
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Telephone | 407-394-4294
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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