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General NPI Number Information
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NPI Number | 1386042026
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Entity Type | Organization
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Legal Business Name | MAXIM-EYES OPTICAL, INC
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Dates
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Enumeration Date | 12/11/2014
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Last Update Date | 12/11/2014
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Provider Practice Location Address
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Address Line | 2547 E STATE ROAD 60
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City | VALRICO
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State | FL
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Zip | 33594-3830
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Country | US
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Telephone | 813-653-9661
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Fax | 813-657-4334
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Provider Business Mailing Address
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Address Line | 2547 E STATE ROAD 60
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City | VALRICO
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State | FL
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Zip | 33594-3830
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Country | US
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Telephone | 813-653-9661
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Fax | 813-657-4334
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Authorized Official
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Title or Position | PRESIDENT
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Name | DULCIE KIFFNER
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Credential |
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Telephone | 813-653-9661
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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 | OPC2050
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | DO4868
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License Number State | FL
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