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General NPI Number Information
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NPI Number | 1174703979
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Entity Type | Organization
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Legal Business Name | BEACH EYE CARE INC
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Dates
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Enumeration Date | 11/08/2007
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Last Update Date | 11/28/2007
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Provider Practice Location Address
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Address Line | 501 PLAZA BLVD
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City | DAYTONA BEACH
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State | FL
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Zip | 32118-3014
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Country | US
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Telephone | 386-677-8040
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Fax | 386-677-8055
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Provider Business Mailing Address
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Address Line | 501 PLAZA BLVD
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City | DAYTONA BEACH
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State | FL
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Zip | 32118-3014
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Country | US
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Telephone | 386-677-8040
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Fax | 386-677-8055
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Authorized Official
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Title or Position | OWNER
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Name | DR. PHILIP GEORGE TOSCANO
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Credential | OD
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Telephone | 386-677-8040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC2890
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License Number State | FL
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