Healthcare Provider Details

I. General information

NPI: 1104051663
Provider Name (Legal Business Name): VENTURE OPTICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 05/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5066 SE FEDERAL HWY
STUART FL
34997-6627
US

IV. Provider business mailing address

5066 SE FEDERAL HWY
STUART FL
34997-6627
US

V. Phone/Fax

Practice location:
  • Phone: 772-286-0022
  • Fax: 772-286-0021
Mailing address:
  • Phone: 772-286-0022
  • Fax: 772-286-0021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number1710
License Number StateFL

VIII. Authorized Official

Name: MRS. BETH VALLETTA
Title or Position: MANAGER
Credential:
Phone: 772-286-0022