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General NPI Number Information
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NPI Number | 1346423902
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Entity Type | Organization
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Legal Business Name | EYEWEAR CENTER OF FLAGLER COUNTY INC.
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Dates
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Enumeration Date | 12/06/2007
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Last Update Date | 12/06/2007
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Provider Practice Location Address
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Address Line | 50 CYPRESS POINT PKWY SUITE C3-4
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City | PALM COAST
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State | FL
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Zip | 32164-2500
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Country | US
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Telephone | 386-446-2020
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Fax | 386-446-6098
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Provider Business Mailing Address
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Address Line | 50 CYPRESS POINT PKWY SUITE C3-4
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City | PALM COAST
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State | FL
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Zip | 32164-2500
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Country | US
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Telephone | 386-446-2020
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Fax | 386-446-6098
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Authorized Official
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Title or Position | MASTER OPTICIAN
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Name | MR. CRAIG ALLAN HENDERSON
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Credential |
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Telephone | 386-446-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | DO1099
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License Number State | FL
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