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General NPI Number Information
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NPI Number | 1528423779
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Entity Type | Organization
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Legal Business Name | WALESBY VISION CENTER P A
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Dates
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Enumeration Date | 12/15/2015
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 24444 STATE ROAD 54
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City | LUTZ
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State | FL
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Zip | 33559-7303
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Country | US
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Telephone | 813-345-8544
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Fax |
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Provider Business Mailing Address
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Address Line | 24444 STATE ROAD 54
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City | LUTZ
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State | FL
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Zip | 33559-7303
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Country | US
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Telephone | 813-345-8544
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. NICHOLAS THOMAS
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Credential | OD
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Telephone | 813-345-8544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | OPC2811
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License Number State | FL
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