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General NPI Number Information
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NPI Number | 1588182562
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Entity Type | Organization
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Legal Business Name | COREN EYE GROUP PLLC
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Dates
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Enumeration Date | 08/30/2017
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Last Update Date | 12/06/2017
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Provider Practice Location Address
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Address Line | 112 E DIXIE AVE
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City | LEESBURG
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State | FL
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Zip | 34748-6350
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Country | US
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Telephone | 352-787-1956
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Fax | 352-365-6690
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Provider Business Mailing Address
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Address Line | 4137 BRIAR GATE LN
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City | WINTER GARDEN
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State | FL
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Zip | 34787-5521
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Country | US
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Telephone | 407-256-3763
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Fax | 407-386-7664
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Authorized Official
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Title or Position | AUTHORIZED MEMBER
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Name | DR. ANDREW VU TRAN
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Credential | OD
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Telephone | 407-256-3763
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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 | 4108
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License Number State | FL
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