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General NPI Number Information
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NPI Number | 1477099877
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Entity Type | Organization
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Legal Business Name | LAKE NONA VISION INC
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Dates
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Enumeration Date | 01/10/2017
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Last Update Date | 01/10/2017
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Provider Practice Location Address
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Address Line | 11920 NARCOOSSEE RD
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City | ORLANDO
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State | FL
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Zip | 32832
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Country | US
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Telephone | 386-334-2705
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Fax |
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Provider Business Mailing Address
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Address Line | 404 SEA DUCK DR
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City | DAYTONA BEACH
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State | FL
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Zip | 32119-1328
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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 | PRESIDENT
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Name | PHUNG MINH HO
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Credential | OD
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Telephone | 386-334-2705
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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 | 5234
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4991
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License Number State | FL
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