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General NPI Number Information
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NPI Number | 1144729120
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Entity Type | Organization
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Legal Business Name | GLADES EYE CARE INCORPORATED
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Dates
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Enumeration Date | 02/06/2018
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Last Update Date | 01/09/2019
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Provider Practice Location Address
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Address Line | 309 SE 2ND ST
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City | BELLE GLADE
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State | FL
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Zip | 33430-3509
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Country | US
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Telephone | 561-996-5804
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Fax | 561-996-7455
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Provider Business Mailing Address
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Address Line | 309 SE 2ND ST
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City | BELLE GLADE
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State | FL
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Zip | 33430-3509
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Country | US
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Telephone | 561-996-5804
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Fax | 561-996-7455
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL DONALD FLIEHS
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Credential | OPTICIAN
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Telephone | 561-996-5804
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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 | FL
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Taxonomy #2
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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