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General NPI Number Information
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NPI Number | 1740471705
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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 | 08/06/2007
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 4133 S. TAMIAMI TRAIL
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City | VENICE
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State | FL
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Zip | 34293
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Country | US
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Telephone | 941-492-9181
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Fax |
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Provider Business Mailing Address
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Address Line | 5607 JOHNS RD
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City | TAMPA
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State | FL
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Zip | 33634-4317
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Country | US
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Telephone | 813-885-3937
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Fax |
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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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