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General NPI Number Information
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NPI Number | 1548703788
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Entity Type | Organization
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Legal Business Name | EYECARE ASSOCIATES OF VIERA
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Dates
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Enumeration Date | 11/21/2016
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Last Update Date | 11/21/2016
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Provider Practice Location Address
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Address Line | 8061 SPYGLASS HILL RD SUITE 104A
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City | VIERA
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State | FL
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Zip | 32940-8297
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Country | US
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Telephone | 321-751-6609
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Fax | 321-751-6033
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Provider Business Mailing Address
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Address Line | 8061 SPYGLASS HILL RD SUITE 104A
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City | VIERA
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State | FL
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Zip | 32940-8297
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Country | US
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Telephone | 321-751-6609
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Fax | 321-751-6033
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHAHAN MANGUIKIAN
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Credential | O.D
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Telephone | 321-751-6609
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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 | OP 2715
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License Number State | FL
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