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General NPI Number Information
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NPI Number | 1538325238
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Entity Type | Organization
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Legal Business Name | MEDICAL ARTS OPTICAL SERVICE,INC
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Dates
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Enumeration Date | 08/01/2008
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Last Update Date | 08/07/2008
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Provider Practice Location Address
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Address Line | 311 N CLYDE MORRIS BLVD SUITE 40
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-2781
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Country | US
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Telephone | 386-253-0041
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Fax |
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Provider Business Mailing Address
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Address Line | 311 N CLYDE MORRIS BLVD SUITE 40
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-2781
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Country | US
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Telephone | 386-253-0041
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. DAVID CHARLES VAUGHAN
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Credential | OPTICIAN
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Telephone | 386-253-0041
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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 | 1903
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License Number State | FL
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