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General NPI Number Information
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NPI Number | 1538459532
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Entity Type | Organization
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Legal Business Name | SERENITY EYE CARE PC
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Dates
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Enumeration Date | 04/11/2011
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Last Update Date | 02/23/2022
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Provider Practice Location Address
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Address Line | 8853 WOODGROVE RIDGE CT
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City | BOYNTON BEACH
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State | FL
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Zip | 33473-4872
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Country | US
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Telephone | 964-593-0902
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Fax |
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Provider Business Mailing Address
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Address Line | 8853 WOODGROVE RIDGE CT
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City | BOYNTON BEACH
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State | FL
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Zip | 33473-4872
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Country | US
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Telephone | 964-593-0902
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TERRI-ANN BAILEY ECHAGUE
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Credential | O.D.
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Telephone | 954-593-0902
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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 | 0618002027
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License Number State | VA
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