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General NPI Number Information
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NPI Number | 1194256545
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Entity Type | Organization
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Legal Business Name | FIRST IMAGE OPTICAL LC
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Dates
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Enumeration Date | 03/27/2017
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Last Update Date | 02/05/2020
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Provider Practice Location Address
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Address Line | 5743 WILLIAMSBURG LN
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City | WILDWOOD
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State | FL
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Zip | 34785-8129
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Country | US
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Telephone | 352-744-7002
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Fax |
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Provider Business Mailing Address
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Address Line | 17562 US HIGHWAY 441
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City | MOUNT DORA
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State | FL
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Zip | 32757-6711
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Country | US
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Telephone | 352-735-2020
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Fax | 352-735-5187
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Authorized Official
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Title or Position | PRESIDENT
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Name | GEORGE L NEAL
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Credential |
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Telephone | 469-214-0144
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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