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General NPI Number Information
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NPI Number | 1417159492
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Entity Type | Organization
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Legal Business Name | FLAMINGO ISLAND OPTICIANS INC
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Dates
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Enumeration Date | 06/02/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 11902 BONITA BEACH RD SE # 9-10B
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-5913
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Country | US
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Telephone | 239-565-6342
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Fax |
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Provider Business Mailing Address
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Address Line | 11061 CHAMPIONSHIP DR
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City | FORT MYERS
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State | FL
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Zip | 33913-8125
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Country | US
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Telephone | 239-565-6342
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Fax |
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Authorized Official
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Title or Position | LICENSED OPTICIAN
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Name | MR. DANIEL G. ACOSTA
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Credential | L.D.O.
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Telephone | 239-565-6342
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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 | OE1318
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | DO4769
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License Number State | FL
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