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General NPI Number Information
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NPI Number | 1831310788
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Entity Type | Organization
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Legal Business Name | EYELAND OPTICAL INC
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 01/18/2012
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Provider Practice Location Address
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Address Line | 851 E 23RD ST
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City | PANAMA CITY
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State | FL
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Zip | 32405-5311
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Country | US
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Telephone | 850-215-3937
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Fax | 850-215-3937
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Provider Business Mailing Address
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Address Line | 851 E 23RD ST
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City | PANAMA CITY
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State | FL
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Zip | 32405-5311
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Country | US
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Telephone | 850-215-3937
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Fax | 850-215-7337
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Authorized Official
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Title or Position | OWNER OPTOMETRIST
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Name | DR. BRENDA A WAINWRIGHT
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Credential | OD
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Telephone | 850-215-3937
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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 |
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License Number State |
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