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General NPI Number Information
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NPI Number | 1124263629
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Entity Type | Organization
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Legal Business Name | GROUP W-A, INC
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Dates
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Enumeration Date | 12/11/2008
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 6585 126TH AVE UNIT D1
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City | LARGO
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State | FL
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Zip | 33773-1836
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Country | US
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Telephone | 727-546-7220
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Fax | 727-546-6641
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Provider Business Mailing Address
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Address Line | 6585 126TH AVE STE D1
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City | LARGO
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State | FL
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Zip | 33773-2161
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Country | US
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Telephone | 727-546-7220
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Fax | 727-546-6641
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID BENTLEY
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Credential | OPTICIAN
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Telephone | 727-546-7220
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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 | OE 1526
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License Number State | FL
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