Healthcare Provider Details

I. General information

NPI: 1124142906
Provider Name (Legal Business Name): SEACREST OPTICAL INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 11/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7263 W ATLANTIC AVE
DELRAY BEACH FL
33446-1305
US

IV. Provider business mailing address

7263 W ATLANTIC AVE
DELRAY BEACH FL
33446-1305
US

V. Phone/Fax

Practice location:
  • Phone: 561-496-2020
  • Fax:
Mailing address:
  • Phone: 561-496-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number1531
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number1531
License Number StateFL

VIII. Authorized Official

Name: MS. SANDRA SCHAINKIN
Title or Position: PRESIDENT OPTICIAN
Credential: L.D.O.
Phone: 561-496-2020