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General NPI Number Information
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NPI Number | 1124142906
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Entity Type | Organization
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Legal Business Name | SEACREST OPTICAL INCORPORATED
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 11/07/2012
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Provider Practice Location Address
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Address Line | 7263 W ATLANTIC AVE
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City | DELRAY BEACH
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State | FL
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Zip | 33446-1305
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Country | US
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Telephone | 561-496-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 7263 W ATLANTIC AVE
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City | DELRAY BEACH
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State | FL
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Zip | 33446-1305
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Country | US
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Telephone | 561-496-2020
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Fax |
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Authorized Official
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Title or Position | PRESIDENT OPTICIAN
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Name | MS. SANDRA SCHAINKIN
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Credential | L.D.O.
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Telephone | 561-496-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 1531
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 1531
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License Number State | FL
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