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General NPI Number Information
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NPI Number | 1134359383
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Entity Type | Organization
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Legal Business Name | FAMILY EYEWEAR
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Dates
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Enumeration Date | 07/22/2009
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Last Update Date | 07/22/2009
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Provider Practice Location Address
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Address Line | 8177 GLADES RD BAY#3
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City | BOCA RATON
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State | FL
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Zip | 33434-4071
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Country | US
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Telephone | 561-479-4765
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Fax | 561-479-4628
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Provider Business Mailing Address
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Address Line | 8177 GLADES RD BAY#3
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City | BOCA RATON
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State | FL
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Zip | 33434-4071
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Country | US
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Telephone | 561-479-4765
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Fax | 561-479-4628
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Authorized Official
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Title or Position | OWNER/LISCENSED OPTICIAN
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Name | DAVID MARC CAMPOREALE
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Credential | L.D.O
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Telephone | 561-479-4765
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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 | 5930
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License Number State | FL
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