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General NPI Number Information
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NPI Number | 1447422548
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Entity Type | Organization
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Legal Business Name | JUSTIN OPTICAL ENTERPRISES INC
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Dates
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Enumeration Date | 03/28/2008
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Last Update Date | 10/02/2008
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Provider Practice Location Address
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Address Line | 2068 N UNIVERSITY DR
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-3608
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Country | US
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Telephone | 954-432-5000
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Fax | 954-432-5001
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Provider Business Mailing Address
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Address Line | 2068 N UNIVERSITY DR
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-3608
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Country | US
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Telephone | 954-432-5000
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Fax | 954-432-5001
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Authorized Official
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Title or Position | PRESIDENT
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Name | JUSTIN M WEININGER
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Credential | OPTICIAN
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Telephone | 954-432-5000
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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 | DO602
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License Number State | FL
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