Provider Demographics
NPI:1285806984
Name:CARROLLWOOD VISION CORPORATION
Entity type:Organization
Organization Name:CARROLLWOOD VISION CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:813-962-1006
Mailing Address - Street 1:3604 MADACA LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618
Mailing Address - Country:US
Mailing Address - Phone:813-962-1006
Mailing Address - Fax:813-269-0600
Practice Address - Street 1:3604 MADACA LN
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2057
Practice Address - Country:US
Practice Address - Phone:813-962-1006
Practice Address - Fax:813-269-0600
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARROLLWOOD VISION CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-02
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1598AMedicare PIN
FLDQ5265Medicare PIN