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General NPI Number Information
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NPI Number | 1952157521
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Entity Type | Organization
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Legal Business Name | PARADISE EYES LLC
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Dates
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Enumeration Date | 04/25/2024
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 4555 14TH ST W
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City | BRADENTON
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State | FL
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Zip | 34207-1429
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Country | US
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Telephone | 813-455-4325
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Fax |
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Provider Business Mailing Address
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Address Line | 23436 COCONUT RUM COURT
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City | BONITA SPRINGS
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State | FL
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Zip | 34134
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Country | US
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Telephone | 239-293-8709
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Fax |
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Authorized Official
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Title or Position | O.D./ OWNER
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Name | DR. MORGAN CHAMPAGNE
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Credential |
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Telephone | 239-293-8709
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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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