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General NPI Number Information
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NPI Number | 1215077557
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Entity Type | Organization
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Legal Business Name | EYESUPPLY
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 785 N WICKHAM RD STE. 106
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City | MELBOURNE
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State | FL
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Zip | 32935-8857
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Country | US
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Telephone | 321-259-3935
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Fax |
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Provider Business Mailing Address
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Address Line | 785 N WICKHAM RD STE. 106
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City | MELBOURNE
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State | FL
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Zip | 32935-8857
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Country | US
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Telephone | 321-259-3935
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Fax |
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MR. EDWARD UCCI
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Credential | ABOC NCLE
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Telephone | 321-259-3935
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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 | OPC2732
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 156FC0801X
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Taxonomy Name | Contact Lens Fitter
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License Number | DO5119
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 156FC0801X
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Taxonomy Name | Contact Lens Fitter
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License Number | DO3652
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | DO5119
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | DO3652
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License Number State | FL
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Taxonomy #6
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | OE1487
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License Number State | FL
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