Provider Demographics
NPI:1902277577
Name:TRINITY VISUAL AND NEUROLOGICAL REHABILITATION CENTER
Entity Type:Organization
Organization Name:TRINITY VISUAL AND NEUROLOGICAL REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:ELLISON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:407-678-9151
Mailing Address - Street 1:3635 ALOMA AVE
Mailing Address - Street 2:SUITE 1029
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6395
Mailing Address - Country:US
Mailing Address - Phone:407-678-9151
Mailing Address - Fax:321-684-7299
Practice Address - Street 1:3635 ALOMA AVE
Practice Address - Street 2:SUITE 1029
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6395
Practice Address - Country:US
Practice Address - Phone:407-678-9151
Practice Address - Fax:321-684-7299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4124261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center