Healthcare Provider Details

I. General information

NPI: 1417159492
Provider Name (Legal Business Name): FLAMINGO ISLAND OPTICIANS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11902 BONITA BEACH RD SE # 9-10B
BONITA SPRINGS FL
34135-5913
US

IV. Provider business mailing address

11061 CHAMPIONSHIP DR
FORT MYERS FL
33913-8125
US

V. Phone/Fax

Practice location:
  • Phone: 239-565-6342
  • Fax:
Mailing address:
  • Phone: 239-565-6342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberDO4769
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberOE1318
License Number StateFL

VIII. Authorized Official

Name: MR. DANIEL G. ACOSTA
Title or Position: LICENSED OPTICIAN
Credential: L.D.O.
Phone: 239-565-6342