Healthcare Provider Details

I. General information

NPI: 1124172291
Provider Name (Legal Business Name): OSPREY OPTICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 S TAMIAMI TRL
SARASOTA FL
34239-3804
US

IV. Provider business mailing address

2121 S TAMIAMI TRL
SARASOTA FL
34239-3804
US

V. Phone/Fax

Practice location:
  • Phone: 941-366-6366
  • Fax: 941-556-3768
Mailing address:
  • Phone: 941-366-6366
  • Fax: 941-556-3768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberDO3873
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberDO3873
License Number StateFL

VIII. Authorized Official

Name: MR. MICHAEL J LOGAN
Title or Position: OPTICIAN
Credential: LDO
Phone: 941-366-6366