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General NPI Number Information
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NPI Number | 1295163657
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Entity Type | Organization
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Legal Business Name | SOUTHWEST ORLANDO EYE CARE LLC
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Dates
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Enumeration Date | 10/23/2013
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Last Update Date | 10/23/2013
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Provider Practice Location Address
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Address Line | 7009 DR PHILLIPS BLVD SUITE 110
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City | ORLANDO
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State | FL
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Zip | 32819-5123
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Country | US
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Telephone | 407-271-8931
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Fax | 407-674-8712
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Provider Business Mailing Address
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Address Line | 7009 DR PHILLIPS BLVD SUITE 110
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City | ORLANDO
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State | FL
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Zip | 32819-5123
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Country | US
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Telephone | 407-271-8931
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Fax | 407-674-8712
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN L NOWELL
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Credential | OD
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Telephone | 407-271-8931
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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 | OP2202
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License Number State | FL
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