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Organization
EYEDENTITY OPTICAL
Active
Organization
EYEDENTITY OPTICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LOUIS MICHAELOS (OWNER)
(727) 585-2200
Entity
Organization
Contact information
Practice address
1030 W BAY DR STE 201, LARGO, FL 33770-3276
(727) 585-2200
Mailing address
1030 W BAY DR STE 201, LARGO, FL 33770-3276
(727) 585-2200
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
NULL
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Enumeration date
07/31/2023
Last updated
07/31/2023
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