Healthcare Provider Details

I. General information

NPI: 1740273879
Provider Name (Legal Business Name): SEA-VIEW OPTICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 S FEDERAL HWY SUITE C-1
DELRAY BEACH FL
33483-3329
US

IV. Provider business mailing address

1715 S FEDERAL HWY SUITE C-1
DELRAY BEACH FL
33483-3329
US

V. Phone/Fax

Practice location:
  • Phone: 561-276-5099
  • Fax: 561-274-9697
Mailing address:
  • Phone: 561-276-5099
  • Fax: 561-274-9697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number1387
License Number StateFL

VIII. Authorized Official

Name: MR. RICHARD W BERGIDA
Title or Position: OPTICIAN
Credential: DO
Phone: 561-276-5099