Healthcare Provider Details

I. General information

NPI: 1598564502
Provider Name (Legal Business Name): COSMIC CONTACT LENSES AND GLASSES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2025
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2761 NW FEDERAL HWY
STUART FL
34994-9258
US

IV. Provider business mailing address

2761 NW FEDERAL HWY
STUART FL
34994-9258
US

V. Phone/Fax

Practice location:
  • Phone: 561-800-4066
  • Fax:
Mailing address:
  • Phone: 561-800-4066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FC0801X
TaxonomyContact Lens Fitter
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: SHIRLEY ALMODOVAR
Title or Position: OWNER LICENSED OPTICIAN
Credential:
Phone: 772-206-0476