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General NPI Number Information
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NPI Number | 1629596200
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Entity Type | Organization
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Legal Business Name | OPTIX
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Dates
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Enumeration Date | 09/05/2017
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Last Update Date | 01/03/2018
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Provider Practice Location Address
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Address Line | 9001 TABORFIELD AVE STE 101
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City | ORLANDO
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State | FL
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Zip | 32836-8905
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Country | US
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Telephone | 407-217-7375
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Fax |
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Provider Business Mailing Address
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Address Line | 9001 TABORFIELD AVE STE 101
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City | ORLANDO
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State | FL
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Zip | 32836-8905
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Country | US
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Telephone | 407-217-7375
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. PAMELA JISELLE BLADE
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Credential | OD
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Telephone | 407-217-7375
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WS0006X
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Taxonomy Name | Sports Vision Optometrist
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License Number | OPC5035
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | OPC5035
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC5035
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License Number State | FL
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