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General NPI Number Information
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NPI Number | 1245681972
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Entity Type | Organization
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Legal Business Name | WIREGRASS OPTICAL LLC
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Dates
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Enumeration Date | 06/23/2016
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Last Update Date | 06/23/2016
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Provider Practice Location Address
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Address Line | 2533 WINDGUARD CIR STE 102
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-7348
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Country | US
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Telephone | 813-991-6060
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Fax |
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Provider Business Mailing Address
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Address Line | 2533 WINDGUARD CIR STE 102
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-7348
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Country | US
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Telephone | 813-991-6060
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Fax |
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Authorized Official
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Title or Position | OPTICIAN/OWNER
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Name | RHONDA SMITH
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Credential | D.O.
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Telephone | 813-991-6060
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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 | OE 2240
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License Number State | FL
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