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General NPI Number Information
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NPI Number | 1801059704
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Entity Type | Organization
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Legal Business Name | EYECARE AND EYEWEAR INC
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Dates
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Enumeration Date | 07/10/2008
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Last Update Date | 11/29/2011
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Provider Practice Location Address
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Address Line | 3402 TECHNOLOGICAL AVE SUITE 124
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City | ORLANDO
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State | FL
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Zip | 32817-1402
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Country | US
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Telephone | 407-208-1890
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Fax |
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Provider Business Mailing Address
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Address Line | 2679 METROSEVILLA DR UNIT 110
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City | ORLANDO
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State | FL
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Zip | 32835-9030
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Country | US
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Telephone | 407-497-6203
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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. LISA S.V BISSESSAR
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Credential | OD
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Telephone | 407-497-6203
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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 | OPC3871
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License Number State | FL
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