=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245357714
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EYES OPTICAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2007
-----------------------------------------------------
Last Update Date | 03/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 246 S FLAMINGO RD
-----------------------------------------------------
City | PEMBROKE PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33027-1721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-443-1230
-----------------------------------------------------
Fax | 954-443-1234
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 246 S FLAMINGO RD
-----------------------------------------------------
City | PEMBROKE PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33027-1721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-443-1230
-----------------------------------------------------
Fax | 954-443-1234
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | DR. MARGARET M BARRETT
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 954-443-1230
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------