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General NPI Number Information
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NPI Number | 1023178852
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Entity Type | Organization
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Legal Business Name | A & M BEACH OPTICAL
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1155 PASADENA AVE S SUITE B
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City | SOUTH PASADENA
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State | FL
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Zip | 33707-2878
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Country | US
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Telephone | 727-343-1521
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Fax | 727-343-2490
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Provider Business Mailing Address
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Address Line | 1155 PASADENA AVE S SUITE B
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City | SOUTH PASADENA
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State | FL
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Zip | 33707-2878
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Country | US
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Telephone | 727-343-1521
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Fax | 727-343-2490
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Authorized Official
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Title or Position | OWNER
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Name | MR. RONALD MILLS
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Credential |
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Telephone | 727-343-1521
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 2489
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License Number State | FL
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