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General NPI Number Information
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NPI Number | 1275743304
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Entity Type | Organization
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Legal Business Name | LIFESTYLE OPTICAL
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 09/11/2008
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Provider Practice Location Address
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Address Line | 89 ROYAL PALM PT
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City | VERO BEACH
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State | FL
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Zip | 32960-4253
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Country | US
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Telephone | 772-567-0707
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Fax | 772-567-5683
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Provider Business Mailing Address
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Address Line | 89 ROYAL PALM PT
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City | VERO BEACH
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State | FL
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Zip | 32960-4253
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Country | US
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Telephone | 772-567-0707
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Fax | 772-567-5683
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOSEPH TESTA
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Credential |
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Telephone | 772-567-0707
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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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