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General NPI Number Information
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NPI Number | 1699089524
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Entity Type | Organization
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Legal Business Name | BAY HILL OCCHIALI
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Dates
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Enumeration Date | 08/03/2010
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Last Update Date | 08/03/2010
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Provider Practice Location Address
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Address Line | 7988 VIA DELLAGIO WAY SUITE 104
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City | ORLANDO
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State | FL
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Zip | 32819-5425
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Country | US
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Telephone | 407-219-3200
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Fax | 407-219-3201
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Provider Business Mailing Address
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Address Line | 7988 VIA DELLAGIO WAY SUITE 104
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City | ORLANDO
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State | FL
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Zip | 32819-5425
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Country | US
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Telephone | 407-219-3200
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Fax | 407-219-3201
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Authorized Official
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Title or Position | CEO
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Name | DR. SEAN P COUGHLIN
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Credential | O.D.
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Telephone | 407-351-3232
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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 | 2778
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License Number State | FL
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