Healthcare Provider Details

I. General information

NPI: 1487090551
Provider Name (Legal Business Name): EYEGLASS WORLD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2013
Last Update Date: 05/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 GULF TO BAY BLVD
CLEARWATER FL
33759-3901
US

IV. Provider business mailing address

296 GRAYSON HWY
LAWRENCEVILLE GA
30046-5737
US

V. Phone/Fax

Practice location:
  • Phone: 727-683-7207
  • Fax: 727-683-7214
Mailing address:
  • Phone: 800-571-5202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: COLTON RITTER
Title or Position: ANALYST
Credential:
Phone: 678-892-3760