Organization
EYEBIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEION MARK OD (MANAGING PROVIDER)
(484) 477-2579
Entity
Organization
Contact information
Practice address
7450 CYPRESS GARDENS BLVD, WINTER HAVEN, FL 33884-6200
(863) 310-0329
(813) 318-0348
Mailing address
2161 E COUNTY ROAD 540A # 254, LAKELAND, FL 33813-3794
(484) 477-2579
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019517900
—
FL
Enumeration date
12/11/2020
Last updated
05/28/2024
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