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General NPI Number Information
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NPI Number | 1972707958
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Entity Type | Organization
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Legal Business Name | TOTAL VISION OF PALM COAST INC
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 07/24/2008
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Provider Practice Location Address
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Address Line | 15 CYPRESS BRANCH WAY SUITE #205
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City | PALM COAST
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State | FL
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Zip | 32164-8413
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Country | US
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Telephone | 386-445-1880
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Fax | 386-445-8796
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Provider Business Mailing Address
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Address Line | 15 CYPRESS BRANCH WAY SUITE #205
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City | PALM COAST
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State | FL
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Zip | 32164-8413
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Country | US
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Telephone | 386-445-1880
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Fax | 386-445-8796
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Authorized Official
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Title or Position | OWNER
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Name | DR. PHILLIP LEE STEPHENS
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Credential | O.D.
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Telephone | 386-445-1880
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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 | OPC 0002395
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License Number State | FL
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