Organization
BUENA VISTA EYELAND INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARLO DANIEL FODOR OD (PRESIDENT)
(772) 388-9330
Entity
Organization
Contact information
Practice address
1619 US HIGHWAY 1, SEBASTIAN, FL 32958-3834
(772) 388-9330
(772) 388-3036
Mailing address
1619 US HIGHWAY 1, SEBASTIAN, FL 32958-3834
(772) 388-9330
(772) 388-3036
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC003794
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
620854100
—
FL
Enumeration date
08/26/2005
Last updated
02/13/2008
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