Provider Demographics
NPI:1316125693
Name:CIAMBRONE VISION OD PL
Entity type:Organization
Organization Name:CIAMBRONE VISION OD PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:CIAMBRONE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:407-390-0585
Mailing Address - Street 1:4444 W VINE ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-5315
Mailing Address - Country:US
Mailing Address - Phone:407-390-0585
Mailing Address - Fax:407-397-9231
Practice Address - Street 1:4444 W VINE ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-5315
Practice Address - Country:US
Practice Address - Phone:407-390-0585
Practice Address - Fax:407-397-9231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3324152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAJ925Medicare PIN
FLU79642Medicare UPIN