Basic Information
| Provider Information | |||||||||
| NPI: | 1265774178 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EYE EXPRESS, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 215 1ST ST N | ||||||||
| Address2: | STE. 100 | ||||||||
| City: | WINTER HAVEN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338814537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8632998908 | ||||||||
| FaxNumber: | 8632991061 | ||||||||
| Practice Location | |||||||||
| Address1: | 3140 CITRUS TOWER BLVD | ||||||||
| Address2: | BLDG 11 | ||||||||
| City: | CLERMONT | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347116888 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8638756568 | ||||||||
| FaxNumber: | 8632991061 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2013 | ||||||||
| LastUpdateDate: | 12/16/2014 | ||||||||
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| AuthorizedOfficialLastName: | SALOMON | ||||||||
| AuthorizedOfficialFirstName: | BRAD | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8638756568 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.