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General NPI Number Information
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NPI Number | 1104002260
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Entity Type | Organization
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Legal Business Name | EYE CANDY OPTICAL LLC
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Dates
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Enumeration Date | 01/18/2008
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Last Update Date | 01/18/2008
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Provider Practice Location Address
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Address Line | 80 BEAL PKWY NW SUITE E
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-4829
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Country | US
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Telephone | 850-226-7096
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Fax |
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Provider Business Mailing Address
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Address Line | 80 BEAL PKWY NW SUITE E
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-4829
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Country | US
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Telephone | 850-226-7096
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CANDICE L REEVE
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Credential | LICENSED OPTICIAN
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Telephone | 850-226-7096
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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 |
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License Number State |
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