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General NPI Number Information
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NPI Number | 1659802288
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Entity Type | Organization
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Legal Business Name | EYE DOCTORS OPTICAL OUTLETS PA
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Dates
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Enumeration Date | 03/24/2017
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 7313 52ND PL E
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City | BRADENTON
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State | FL
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Zip | 34203-8915
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Country | US
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Telephone | 941-758-4902
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Fax | 941-877-2942
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Provider Business Mailing Address
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Address Line | 7313 52ND PL E
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City | BRADENTON
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State | FL
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Zip | 34203-8915
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Country | US
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Telephone | 941-758-4902
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Fax | 941-877-2942
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT C. COPPOLA
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Credential | OD
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Telephone | 954-917-2337
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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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