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NPI Code Detail

MEDICARE: OPTIKK 30A, PA

MEDICARE: OPTIKK 30A, PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332H00000XEyewear SupplierOPC3910FL
2152W00000XOptometristOPC 3910FL

General Provider Information

NPI Number : 1487031233
Entity Type Code : Organization
Provider Name (Legal Business Name) : OPTIKK 30A, PA
Provider Business Mailing Address
First Line : 2050 HWY 30A
Second Line : M 1-119
City : SANTA ROSA BEACH
State : FL
Zip : 32459
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2050 W COUNTY HIGHWAY 30A
Second Line : M1-119
City : SANTA ROSA BEACH
State : FL
Zip : 32459-0187
Country : US
Telephone Number : 850-608-3135
Fax Number :
Authorized Official
Title or Position : CEO
Name : DR. KORRIE L LALIM
Credential : O.D.
Telephone Number : 850-608-3135
Provider Enumeration Date : 04/30/2015
Last Update Date : 03/15/2016

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Directions to “OPTIKK 30A, PA ” Practice Location

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