Provider Demographics
NPI:1396049607
Name:EYESHOPPE OF ORLANDO, LLC
Entity type:Organization
Organization Name:EYESHOPPE OF ORLANDO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:HERNANDEZ
Authorized Official - Last Name:UYCOCO
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:407-382-7701
Mailing Address - Street 1:10209 E COLONIAL DR
Mailing Address - Street 2:130
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-4306
Mailing Address - Country:US
Mailing Address - Phone:407-382-7701
Mailing Address - Fax:407-382-7702
Practice Address - Street 1:10209 E COLONIAL DR
Practice Address - Street 2:130
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-4306
Practice Address - Country:US
Practice Address - Phone:407-382-7701
Practice Address - Fax:407-382-7702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOE1930332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier