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General NPI Number Information
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NPI Number | 1003280306
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Entity Type | Organization
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Legal Business Name | EYE-SITE OF BOYNTON BEACH
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Dates
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Enumeration Date | 11/24/2015
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Last Update Date | 11/24/2015
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Provider Practice Location Address
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Address Line | 6641 W BOYNTON BEACH BLVD
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City | BOYNTON BEACH
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State | FL
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Zip | 33437-3527
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Country | US
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Telephone | 561-738-0111
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Fax | 561-735-9359
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Provider Business Mailing Address
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Address Line | 6641 W BOYNTON BEACH BLVD
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City | BOYNTON BEACH
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State | FL
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Zip | 33437
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Country | US
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Telephone | 561-738-0111
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Fax | 561-735-9359
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Authorized Official
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Title or Position | OWNER
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Name | MR. DAVID MILES THOMAS
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Credential | L.D.O
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Telephone | 561-738-0111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 5095
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License Number State | FL
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