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General NPI Number Information
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NPI Number | 1417006073
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Entity Type | Organization
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Legal Business Name | TAYLOR CREEK OPTICAL INC
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 08/17/2018
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Provider Practice Location Address
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Address Line | 104 N 2ND ST
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City | FORT PIERCE
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State | FL
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Zip | 34950
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Country | US
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Telephone | 772-468-0008
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Fax | 772-468-6628
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Provider Business Mailing Address
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Address Line | 104 N 2ND ST
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City | FORT PIERCE
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State | FL
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Zip | 34950-4403
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Country | US
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Telephone | 772-468-0008
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Fax | 772-468-6628
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILLIAM EDWARD PALMER
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Credential |
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Telephone | 772-468-0008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | DO3798
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | OE480
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License Number State | FL
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