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General NPI Number Information
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NPI Number | 1023279460
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Entity Type | Organization
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Legal Business Name | MAYFAIR REGENCY INC.
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Dates
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Enumeration Date | 06/18/2008
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 9430 ARLINGTON EXPY
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City | JACKSONVILLE
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State | FL
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Zip | 32225-8231
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Country | US
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Telephone | 904-725-2020
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Fax | 904-725-4262
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Provider Business Mailing Address
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Address Line | 9430 ARLINGTON EXPY
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City | JACKSONVILLE
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State | FL
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Zip | 32225-8231
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Country | US
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Telephone | 904-725-2020
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JONATHAN PAUL LOCKERMAN
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Credential | OPTICIAN
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Telephone | 904-725-2020
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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 | DO9859
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License Number State | FL
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