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General NPI Number Information
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NPI Number | 1205351418
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Entity Type | Organization
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Legal Business Name | EAGLE VISION EYE CARE LLC
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Dates
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Enumeration Date | 08/08/2017
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Last Update Date | 08/08/2017
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Provider Practice Location Address
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Address Line | 978 INTERNATIONAL PKWY STE 1400
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City | LAKE MARY
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State | FL
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Zip | 32746-5219
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Country | US
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Telephone | 407-324-3633
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Fax |
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Provider Business Mailing Address
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Address Line | 978 INTERNATIONAL PKWY STE 1400
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City | LAKE MARY
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State | FL
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Zip | 32746-5219
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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 | MANAGER
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Name | DR. CALVIN NAZARIO
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Credential | OD
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Telephone | 386-216-4117
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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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