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General NPI Number Information
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NPI Number | 1902134612
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Entity Type | Organization
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Legal Business Name | PRIMARY EYE CARE OF FLORIDA, LLC
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Dates
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Enumeration Date | 11/19/2009
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Last Update Date | 11/19/2009
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Provider Practice Location Address
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Address Line | 9409 US HIGHWAY 19 STE 101
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City | PORT RICHEY
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State | FL
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Zip | 34668-4626
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Country | US
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Telephone | 727-846-6235
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Fax |
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Provider Business Mailing Address
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Address Line | 7442 TRANSOM CT
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City | TAMPA
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State | FL
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Zip | 33607-5870
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Country | US
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Telephone | 727-846-6235
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. RIZ JUAN KHAN
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Credential | OD
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Telephone | 407-401-0530
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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 | OPC3811
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License Number State | FL
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