1932424496 NPI number — TUCKER EYE-EXAM & CONTACT LENS CENTER

Table of content: (NPI 1932424496)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932424496 NPI number — TUCKER EYE-EXAM & CONTACT LENS CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TUCKER EYE-EXAM & CONTACT LENS CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932424496
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3955 HUNTERS RIDGE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TITUSVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32796-1855
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-361-5202
Provider Business Mailing Address Fax Number:
800-878-9609

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12950 E COLONIAL DR
Provider Second Line Business Practice Location Address:
SUITE # 100
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32826-4609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-361-5205
Provider Business Practice Location Address Fax Number:
800-878-9609
Provider Enumeration Date:
03/28/2010

Additional Information

Authorized Official

Authorized Official Last Name:
TUCKER
Authorized Official First Name:
MARIANN
Authorized Official Middle Name:
LOUISE
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
352-361-5205

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  FL OPC #1977 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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