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General NPI Number Information
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NPI Number | 1396918561
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Entity Type | Organization
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Legal Business Name | OCEAN OPTICAL
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Dates
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Enumeration Date | 04/09/2008
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Last Update Date | 04/25/2008
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Provider Practice Location Address
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Address Line | 600 N RIDGEWOOD AVE
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City | EDGEWATER
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State | FL
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Zip | 32132-1659
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Country | US
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Telephone | 386-423-2239
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Fax |
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Provider Business Mailing Address
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Address Line | 600 N RIDGEWOOD AVE
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City | EDGEWATER
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State | FL
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Zip | 32132-1659
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Country | US
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Telephone | 386-423-2239
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Fax |
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Authorized Official
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Title or Position | OWNER/LICENSED OPTICIAN
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Name | MR. TIMOTHY RAY NOLAN
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Credential |
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Telephone | 386-423-2239
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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 | 2275
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License Number State | FL
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