Organization
OPTIX
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAMELA JISELLE BLADE OD (OPTOMETRIST/OWNER)
(407) 217-7375
Entity
Organization
Contact information
Practice address
9001 TABORFIELD AVE STE 101, ORLANDO, FL 32836-8905
(407) 217-7375
Mailing address
9001 TABORFIELD AVE STE 101, ORLANDO, FL 32836-8905
(407) 217-7375
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC5035
FL
152WS0006X
Sports Vision Optometrist
OPC5035
FL
152WV0400X
Vision Therapy Optometrist
OPC5035
FL
Other
Enumeration date
09/05/2017
Last updated
01/03/2018
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