=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700807682
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAYHEAD EYE CENTRE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2006
-----------------------------------------------------
Last Update Date | 02/11/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 820 W LAKE MARY BLVD SUITE # 104
-----------------------------------------------------
City | SANFORD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32773-5946
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-322-2230
-----------------------------------------------------
Fax | 407-330-6287
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 820 W LAKE MARY BLVD SUITE # 104
-----------------------------------------------------
City | SANFORD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32773-5946
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-322-2230
-----------------------------------------------------
Fax | 407-330-6287
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | DR. MONA PATEL
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 407-322-2230
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OPL1438
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------