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General NPI Number Information
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NPI Number | 1750577490
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Entity Type | Organization
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Legal Business Name | ADVANCED EYE CARE OF CENTRAL FLORIDA INC
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Dates
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Enumeration Date | 09/17/2007
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Last Update Date | 04/13/2020
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Provider Practice Location Address
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Address Line | 5680 WAYSIDE DR
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City | SANFORD
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State | FL
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Zip | 32771-8625
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Country | US
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Telephone | 407-333-3937
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Fax | 407-333-4500
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Provider Business Mailing Address
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Address Line | 5680 WAYSIDE DR
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City | SANFORD
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State | FL
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Zip | 32771-8625
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Country | US
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Telephone | 407-333-3937
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Fax | 407-333-4500
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHRISTY L LARSON
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Credential | O.D.
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Telephone | 407-333-3937
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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 | OPC 3015
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC 3069
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License Number State | FL
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