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General NPI Number Information
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NPI Number | 1104164391
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Entity Type | Organization
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Legal Business Name | DESIGNING EYES OPTICAL BOUTIQUE, INC
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Dates
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Enumeration Date | 01/22/2013
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Last Update Date | 01/22/2013
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Provider Practice Location Address
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Address Line | 200 N TAMPA ST SUITE G110
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City | TAMPA
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State | FL
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Zip | 33602-5161
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Country | US
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Telephone | 813-229-0551
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Fax |
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Provider Business Mailing Address
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Address Line | 200 N TAMPA ST SUITE G110
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City | TAMPA
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State | FL
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Zip | 33602-5161
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Country | US
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Telephone | 813-229-0551
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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 | MS. SHARON DENISE KYTE
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Credential |
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Telephone | 813-229-0551
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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 | 2370
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License Number State | FL
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