Provider Demographics
NPI:1902134612
Name:PRIMARY EYE CARE OF FLORIDA, LLC
Entity Type:Organization
Organization Name:PRIMARY EYE CARE OF FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RIZ
Authorized Official - Middle Name:JUAN
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:407-401-0530
Mailing Address - Street 1:7442 TRANSOM CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-5870
Mailing Address - Country:US
Mailing Address - Phone:727-846-6235
Mailing Address - Fax:
Practice Address - Street 1:9409 US HIGHWAY 19 STE 101
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-4626
Practice Address - Country:US
Practice Address - Phone:727-846-6235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3811152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty