# EYEDENTITY OPTICAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174204275
- **Authorized official:** LOUIS MICHAELOS (OWNER)
- **Authorized official phone:** (727) 585-2200

## Contact information

- **Practice address:** 1030 W BAY DR STE 201, LARGO, FL 33770-3276
- **Practice address phone:** (727) 585-2200
- **Mailing address:** 1030 W BAY DR STE 201, LARGO, FL 33770-3276
- **Mailing address phone:** (727) 585-2200

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/31/2023
- **Last updated:** 07/31/2023