=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386113843
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EYES ON THE GO OPTICAL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2018
-----------------------------------------------------
Last Update Date | 01/10/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6618 STIRLING RD
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33024-1954
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-812-9232
-----------------------------------------------------
Fax | 954-374-6783
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6618 STIRLING RD
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33024-1954
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-812-9232
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CARMEN GLADYS GARCIA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 954-812-9232
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 156FX1800X
-----------------------------------------------------
Taxonomy Name | Optician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------