Provider Demographics
NPI:1043721202
Name:EYE DOCTORS OPTICAL OUTLETS, PA
Entity type:Organization
Organization Name:EYE DOCTORS OPTICAL OUTLETS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:COPPOLA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-917-2337
Mailing Address - Street 1:5607 JOHNS RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-4499
Mailing Address - Country:US
Mailing Address - Phone:813-885-3937
Mailing Address - Fax:
Practice Address - Street 1:140 E 13TH ST
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-4703
Practice Address - Country:US
Practice Address - Phone:321-766-7800
Practice Address - Fax:321-418-6108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-16
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty