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General NPI Number Information
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NPI Number | 1982101572
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Entity Type | Organization
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Legal Business Name | OPTICARE MEDICINE, PLLC
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Dates
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Enumeration Date | 04/10/2018
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Last Update Date | 04/10/2018
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Provider Practice Location Address
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Address Line | 9400 TURKEY LAKE RD
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City | ORLANDO
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State | FL
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Zip | 32819-8001
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Country | US
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Telephone | 352-409-3680
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Fax | 352-483-7499
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Provider Business Mailing Address
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Address Line | PO BOX3349
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City | WINDERMERE
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State | FL
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Zip | 34786-3349
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Country | US
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Telephone | 352-409-3680
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Fax | 352-483-7499
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Authorized Official
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Title or Position | BUSINES MANAGER
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Name | PAMALA MARION ROY
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Credential |
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Telephone | 352-409-3680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 13607
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License Number State | FL
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