# BUENA VISTA EYELAND INC

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

## Provider details

- **NPI number:** 1205829033
- **Authorized official:** DR. CARLO DANIEL FODOR OD (PRESIDENT)
- **Authorized official phone:** (772) 388-9330

## Contact information

- **Practice address:** 1619 US HIGHWAY 1, SEBASTIAN, FL 32958-3834
- **Practice address phone:** (772) 388-9330
- **Practice address fax:** (772) 388-3036
- **Mailing address:** 1619 US HIGHWAY 1, SEBASTIAN, FL 32958-3834
- **Mailing address phone:** (772) 388-9330
- **Mailing address fax:** (772) 388-3036

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | OPC003794 | FL | Yes |

## Other

- **Enumeration date:** 08/26/2005
- **Last updated:** 02/13/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 620854100 | — | FL |