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General NPI Number Information
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NPI Number | 1235498932
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Entity Type | Organization
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Legal Business Name | EYEGLASS WORLD
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Dates
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Enumeration Date | 05/15/2012
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Last Update Date | 05/15/2012
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Provider Practice Location Address
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Address Line | 2109 66TH STREET N.
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City | ST. PETERSBURG
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State | FL
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Zip | 33710
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Country | US
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Telephone | 727-342-5226
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Fax | 727-342-5231
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Provider Business Mailing Address
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Address Line | 296 GRAYSON HWY
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-5737
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Country | US
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Telephone | 770-822-3600
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Fax |
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Authorized Official
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Title or Position | MC ASST
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Name | SUSAN EDICK
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Credential |
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Telephone | 678-892-3774
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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 |
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