Healthcare Provider Details

I. General information

NPI: 1447424858
Provider Name (Legal Business Name): ROBERTS OPTICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 07/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 NE 44TH ST
OAKLAND PARK FL
33334-1437
US

IV. Provider business mailing address

23 NE 44TH ST
OAKLAND PARK FL
33334-1437
US

V. Phone/Fax

Practice location:
  • Phone: 954-776-0363
  • Fax: 954-776-4262
Mailing address:
  • Phone: 954-776-0363
  • Fax: 954-776-4262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1603
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number1603
License Number StateFL

VIII. Authorized Official

Name: ROBERT E. MANN
Title or Position: OWNER/OPTICIAN
Credential:
Phone: 954-776-0363