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General NPI Number Information
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NPI Number | 1811544885
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Entity Type | Organization
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Legal Business Name | PERCEPTION VISION CARE
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Dates
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Enumeration Date | 08/23/2019
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Last Update Date | 08/23/2019
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Provider Practice Location Address
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Address Line | 3435 49TH ST N
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City | ST PETERSBURG
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State | FL
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Zip | 33710-2147
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Country | US
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Telephone | 727-776-0136
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Fax |
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Provider Business Mailing Address
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Address Line | 11586 MURRAY AVE
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City | SEMINOLE
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State | FL
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Zip | 33778-2912
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OD
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Name | JENNIFER SCURLOCK
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Credential | OD
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Telephone | 727-776-0136
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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