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General NPI Number Information
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NPI Number | 1649866815
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Entity Type | Organization
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Legal Business Name | EYEBIS
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Dates
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Enumeration Date | 12/11/2020
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Last Update Date | 05/28/2024
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Provider Practice Location Address
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Address Line | 7450 CYPRESS GARDENS BLVD
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City | WINTER HAVEN
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State | FL
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Zip | 33884-6200
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Country | US
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Telephone | 863-310-0329
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Fax | 813-318-0348
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Provider Business Mailing Address
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Address Line | 2161 E COUNTY ROAD 540A # 254
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City | LAKELAND
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State | FL
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Zip | 33813-3794
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Country | US
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Telephone | 484-477-2579
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Fax |
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Authorized Official
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Title or Position | MANAGING PROVIDER
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Name | KEION MARK
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Credential | OD
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Telephone | 484-477-2579
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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 |
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