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General NPI Number Information
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NPI Number | 1003913419
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Entity Type | Organization
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Legal Business Name | KLASSY EYES INC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 07/29/2008
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Provider Practice Location Address
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Address Line | KLASSY EYES OPTICAL 7050 W PALMETTO PARK ROAD SUITE36
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City | BOCA RATON
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State | FL
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Zip | 33433-3463
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Country | US
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Telephone | 561-394-8777
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Fax |
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Provider Business Mailing Address
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Address Line | 4036 NW 3RD AVE
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City | BOCA RATON
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State | FL
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Zip | 33431-4101
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Country | US
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Telephone | 561-394-5815
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MR. KENNETH ALAN DI CERBO
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Credential | OPTICIAN
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Telephone | 561-394-8777
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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 | 2782
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License Number State | FL
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