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General NPI Number Information
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NPI Number | 1275978835
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Entity Type | Organization
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Legal Business Name | COLEAN SERVICES, INC.
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Dates
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Enumeration Date | 05/08/2013
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Last Update Date | 05/08/2013
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Provider Practice Location Address
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Address Line | 10855 S FEDERAL HWY
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-6410
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Country | US
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Telephone | 772-337-4476
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Fax | 772-335-9258
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Provider Business Mailing Address
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Address Line | 10855 S FEDERAL HWY
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-6410
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Country | US
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Telephone | 772-337-4476
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Fax | 772-335-9258
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN EDWIN COLEAN
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Credential | O.D.
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Telephone | 772-337-4476
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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 | FLOPC002229
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License Number State | FL
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