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NPI Code Detail

MEDICARE: EYE DOCTORS OPTICAL OUTLETS, PA

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
1152W00000XOptometrist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1740515105
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 :
Provider Business Practice Location Address
First Line : 6417 E COUNTY LINE RD STE 102
Second Line :
City : TAMPA
State : FL
Zip : 33647-1855
Country : US
Telephone Number : 813-885-3937
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. ROBERT C. COPPOLA
Credential : OD
Telephone Number : 954-917-2337
Provider Enumeration Date : 10/02/2009
Last Update Date : 01/31/2025

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1659264521 — CAROLYN MICHELLE BLANCO
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Directions to “EYE DOCTORS OPTICAL OUTLETS, PA ” Practice Location

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