MEDICARE: EYE DOCTORS OPTICAL OUTLETS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1164308771
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE DOCTORS OPTICAL OUTLETS PA

Provider Business Mailing Address
First Line	:	5607 JOHNS RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-4499
Country	:	US
Telephone Number	:	813-885-3937
Fax Number	:	813-880-8375

Provider Business Practice Location Address
First Line	:	6017 S GOLDENROD RD STE A
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-8778
Country	:	US
Telephone Number	:	407-351-6063
Fax Number	:	407-232-6066

Authorized Official
Title or Position	:	OWNER
Name	:	ROBERT C. COPPOLA
Credential	:	OD
Telephone Number	:	813-885-3937

Provider Enumeration Date	:	08/12/2025
Last Update Date	:	01/21/2026

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