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General NPI Number Information
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NPI Number | 1548572571
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Entity Type | Organization
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Legal Business Name | FLORIDA OPTICAL ENTERPRISES, INC.
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Dates
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Enumeration Date | 07/07/2010
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Last Update Date | 10/15/2010
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Provider Practice Location Address
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Address Line | 1011 W VINE ST
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City | KISSIMMEE
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State | FL
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Zip | 34741-4166
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Country | US
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Telephone | 407-343-0567
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Fax | 407-944-1030
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Provider Business Mailing Address
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Address Line | 1011 W VINE ST
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City | KISSIMMEE
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State | FL
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Zip | 34741-4166
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Country | US
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Telephone | 407-343-0567
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Fax | 407-944-1030
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Authorized Official
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Title or Position | OWNER
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Name | MR. LATCHMAN HARDOWAR
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Credential | M.D
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Telephone | 407-343-0567
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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 | OPC3905
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License Number State | FL
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