Provider Demographics
NPI:1699089524
Name:BAY HILL OCCHIALI
Entity type:Organization
Organization Name:BAY HILL OCCHIALI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:COUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:407-351-3232
Mailing Address - Street 1:7988 VIA DELLAGIO WAY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5425
Mailing Address - Country:US
Mailing Address - Phone:407-219-3200
Mailing Address - Fax:407-219-3201
Practice Address - Street 1:7988 VIA DELLAGIO WAY
Practice Address - Street 2:SUITE 104
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5425
Practice Address - Country:US
Practice Address - Phone:407-219-3200
Practice Address - Fax:407-219-3201
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUGHLIN EYE CENTER PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2778152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty