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General NPI Number Information
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NPI Number | 1467657494
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Entity Type | Organization
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Legal Business Name | SOUTHSHORE OPTICIANS BOCA INC
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Dates
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Enumeration Date | 06/19/2007
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Last Update Date | 02/16/2008
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Provider Practice Location Address
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Address Line | 1944 NE 5TH AVE
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City | BOCA RATON
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State | FL
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Zip | 33431-7702
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Country | US
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Telephone | 561-368-2878
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Fax |
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Provider Business Mailing Address
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Address Line | 1944 NE 5TH AVE
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City | BOCA RATON
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State | FL
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Zip | 33431-7702
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Country | US
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Telephone | 561-368-2878
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Fax |
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | RICHARD FREEDMAN
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Credential |
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Telephone | 561-368-2878
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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 | DO5086
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License Number State | FL
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