| NPI | 1083613095 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH WILLIAM SPADAFORA Owner 941-625-1325 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL 4095) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL 4095) |
| 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: FL 79133) | |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2020-09-03 |