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General NPI Number Information
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NPI Number | 1649342767
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Entity Type | Organization
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Legal Business Name | THAYER EYE CARE PA
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 09/19/2011
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Provider Practice Location Address
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Address Line | 27 US 27 S
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City | LAKE PLACID
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State | FL
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Zip | 33852-7916
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Country | US
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Telephone | 863-465-4904
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Fax | 863-465-4650
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Provider Business Mailing Address
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Address Line | 27 US 27 S
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City | LAKE PLACID
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State | FL
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Zip | 33852-7916
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Country | US
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Telephone | 863-465-4904
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Fax | 863-465-4650
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Authorized Official
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Title or Position | PRESIDENT-OWNER
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Name | DR. GLENN R THAYER
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Credential | OD
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Telephone | 863-465-4904
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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 |
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License Number State | FL
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