Healthcare Provider Details

I. General information

NPI: 1285862912
Provider Name (Legal Business Name): MNS OPTIX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 07/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22191 POWERLINE RD STE 26C
BOCA RATON FL
33433-5019
US

IV. Provider business mailing address

22191 POWERLINE RD STE 26C
BOCA RATON FL
33433-5019
US

V. Phone/Fax

Practice location:
  • Phone: 561-544-6924
  • Fax: 561-544-6925
Mailing address:
  • Phone: 561-544-6924
  • Fax: 561-544-6925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberDO5895
License Number StateFL

VIII. Authorized Official

Name: MONY SCHEBOVITZ
Title or Position: OWNER
Credential:
Phone: 561-544-6924