# 1162 MILITARY TRAIL LLC

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

## Provider details

- **NPI number:** 1841572427
- **Authorized official:** STEPHEN MCCORMACK (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (877) 881-0022

## Contact information

- **Practice address:** 7326 LAKE UNDERHILL RD, ORLANDO, FL 32822-6055
- **Practice address phone:** (407) 380-2020
- **Mailing address:** 7326 LAKE UNDERHILL RD, ORLANDO, FL 32822-6055
- **Mailing address phone:** (407) 380-2020

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | — | NULL | Yes |
| 152W00000X | Optometrist | — | — | Yes |

## Other

- **Enumeration date:** 09/09/2011
- **Last updated:** 09/09/2011