Organization
LAKE NONA VISION INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHUNG MINH HO OD (PRESIDENT)
(386) 334-2705
Entity
Organization
Contact information
Practice address
11920 NARCOOSSEE RD, ORLANDO, FL 32832
(386) 334-2705
Mailing address
404 SEA DUCK DR, DAYTONA BEACH, FL 32119-1328
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4991
FL
152W00000X
Optometrist
5234
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
014476800
—
FL
Enumeration date
01/10/2017
Last updated
01/10/2017
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