Healthcare Provider Details

I. General information

NPI: 1346432044
Provider Name (Legal Business Name): VANBUSKIRK OPTICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 06/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

798 NEAPOLITAN WAY
NAPLES FL
34103-8504
US

IV. Provider business mailing address

798 NEAPOLITAN WAY
NAPLES FL
34103-8504
US

V. Phone/Fax

Practice location:
  • Phone: 239-649-1011
  • Fax: 239-649-7752
Mailing address:
  • Phone: 239-649-1011
  • Fax: 239-649-7752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberDE0000110
License Number StateFL

VIII. Authorized Official

Name: MR. M TODD VANBUSKIRK
Title or Position: LICENSED OPTICIAN
Credential:
Phone: 239-649-1011