Basic Information
| Provider Information | |||||||||
| NPI: | 1528737806 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TVO OF FL PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 PERIMETER PARK DR STE D | ||||||||
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| City: | MORRISVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275609714 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4788 HODGES BLVD STE 205 | ||||||||
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| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322247223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9049929991 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2021 | ||||||||
| LastUpdateDate: | 09/09/2021 | ||||||||
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| AuthorizedOfficialLastName: | TENER | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 9192059249 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.