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NPI Code Detail

MEDICARE: PHAN-TASTIC EYE CARE LLC

MEDICARE: PHAN-TASTIC EYE CARE LLC
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

General Provider Information

NPI Number : 1841151925
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHAN-TASTIC EYE CARE LLC
Provider Business Mailing Address
First Line : 1488 VIA SANGRO PL
Second Line :
City : WINTER PARK
State : FL
Zip : 32792-6243
Country : US
Telephone Number : 407-435-3175
Fax Number :
Provider Business Practice Location Address
First Line : 820 OVIEDO MALL BLVD
Second Line :
City : OVIEDO
State : FL
Zip : 32765-9348
Country : US
Telephone Number : 321-348-3026
Fax Number :
Authorized Official
Title or Position : OPTOMETRIST
Name : BAO PHAN
Credential : OD
Telephone Number : 407-435-3175
Provider Enumeration Date : 11/19/2025
Last Update Date : 11/19/2025

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Directions to “PHAN-TASTIC EYE CARE LLC ” Practice Location

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