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General NPI Number Information
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NPI Number | 1598351181
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Entity Type | Organization
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Legal Business Name | HANLEY OPTICAL LLC
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Dates
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Enumeration Date | 12/17/2020
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Last Update Date | 12/17/2020
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Provider Practice Location Address
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Address Line | 751 OAK ST STE 200
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City | JACKSONVILLE
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State | FL
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Zip | 32204-3361
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Country | US
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Telephone | 904-619-9078
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Fax | 904-619-9079
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Provider Business Mailing Address
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Address Line | 3120 E BANISTER RD
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City | ST AUGUSTINE
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State | FL
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Zip | 32092-3028
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Country | US
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Telephone | 904-619-9078
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHELLE BRADLEY
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Credential | OD
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Telephone | 904-619-9078
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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 |
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License Number State |
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