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General NPI Number Information
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NPI Number | 1346087509
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Entity Type | Organization
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Legal Business Name | INFINITY VISION OPTICAL BOUTIQUE
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Dates
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Enumeration Date | 07/13/2024
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Last Update Date | 07/13/2024
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Provider Practice Location Address
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Address Line | 5135 INTERNATIONAL DR STE 15
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City | ORLANDO
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State | FL
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Zip | 32819-9451
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Country | US
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Telephone | 407-745-4066
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Fax | 407-745-4067
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Provider Business Mailing Address
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Address Line | 5135 INTERNATIONAL DR STE 15
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City | ORLANDO
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State | FL
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Zip | 32819-9451
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Country | US
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Telephone | 908-696-3463
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DIEGO LUCIANO PIRES
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Credential | DO
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Telephone | 908-696-3463
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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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