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General NPI Number Information
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NPI Number | 1376302679
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Entity Type | Organization
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Legal Business Name | OPTICAL EXPERIENCE LLC
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Dates
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Enumeration Date | 03/18/2024
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 5601 CORPORATE WAY STE 117
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City | WEST PALM BEACH
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State | FL
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Zip | 33407-2041
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Country | US
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Telephone | 561-401-0902
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Fax | 561-203-1692
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Provider Business Mailing Address
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Address Line | 218 LYMAN PL
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-3708
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Country | US
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Telephone | 561-566-0830
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Fax | 561-203-1692
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Authorized Official
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Title or Position | OWNER
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Name | MS. DESTYNEE TURNER
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Credential | LDO
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Telephone | 561-401-0902
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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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