Healthcare Provider Details

I. General information

NPI: 1003099862
Provider Name (Legal Business Name): THE EYEGLASS MAN INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2007
Last Update Date: 12/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5865 N UNIVERSITY DR
TAMARAC FL
33321-4617
US

IV. Provider business mailing address

5865 N UNIVERSITY DR
TAMARAC FL
33321-4617
US

V. Phone/Fax

Practice location:
  • Phone: 954-721-5520
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberFL1019
License Number StateFL

VIII. Authorized Official

Name: MR. MARTIN LEVINE
Title or Position: PRES./OPTICIAN
Credential:
Phone: 954-721-5520