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General NPI Number Information
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NPI Number | 1477235752
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Entity Type | Organization
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Legal Business Name | TREASURE FORD OPTICS
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Dates
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Enumeration Date | 08/04/2023
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Last Update Date | 08/04/2023
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Provider Practice Location Address
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Address Line | 4239 W COMMERCIAL BLVD
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City | TAMARAC
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State | FL
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Zip | 33319-3305
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Country | US
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Telephone | 754-202-5505
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Fax |
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Provider Business Mailing Address
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Address Line | 4239 W COMMERCIAL BLVD
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City | TAMARAC
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State | FL
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Zip | 33319-3305
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Country | US
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Telephone | 754-202-5505
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Fax |
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Authorized Official
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Title or Position | SUPERVISOR
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Name | MISS SHELLNELL PETTIFORD
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Credential | OPTICIAN
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Telephone | 754-224-0594
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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