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Organization

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Active
Organization subpart
No

Provider details

NPI number
Authorized official
ALBERT EVANS O.D. (OWNER)
(239) 573-8774
Entity
Organization

Contact information

Practice address
325 NORTH DEL PRADO, CAPE CORAL, FL 33909
(239) 573-8774
Mailing address
P. O. BOX 150026, CAPE CORAL, FL 33915
(239) 573-8774

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC 1738
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
GT597A
PTAN
FL
Enumeration date
12/22/2006
Last updated
12/19/2012
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