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General NPI Number Information
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NPI Number | 1215267844
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Entity Type | Organization
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Legal Business Name | NEVILLE EYE GROUPPA
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Dates
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Enumeration Date | 01/04/2010
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Last Update Date | 01/04/2010
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Provider Practice Location Address
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Address Line | 9409 US HIGHWAY 19
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City | PORT RICHEY
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State | FL
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Zip | 34668-4625
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Country | US
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Telephone | 727-846-1972
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Fax |
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Provider Business Mailing Address
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Address Line | 2085 VICTORY AVE
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City | LARGO
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State | FL
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Zip | 33770-4907
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Country | US
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Telephone | 207-266-9198
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. ELIZABETH M GARLAND
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Credential | O.D.
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Telephone | 207-266-9198
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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 | 4409
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License Number State | FL
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