Basic Information
| Provider Information | |||||||||
| NPI: | 1740917665 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SURE VISION CENTERS OF FLORIDA PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11058 GRANDE PINES CIR APT 823 | ||||||||
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| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328219333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8133559543 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11830 GLASS HOUSE LANE | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8133559543 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2022 | ||||||||
| LastUpdateDate: | 08/02/2022 | ||||||||
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| AuthorizedOfficialLastName: | SIMEUS | ||||||||
| AuthorizedOfficialFirstName: | ANGELINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8133559543 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
| NPICertificationDate: | 07/22/2022 | ||||||||
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.