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General NPI Number Information
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NPI Number | 1609049394
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Entity Type | Organization
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Legal Business Name | LIFESTYLE OPTICIANS
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Dates
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Enumeration Date | 04/02/2008
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Last Update Date | 04/02/2008
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Provider Practice Location Address
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Address Line | 7183 PEMBROKE RD
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City | PEMBROKE PINES
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State | FL
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Zip | 33023-2626
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Country | US
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Telephone | 954-981-5455
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Fax | 954-981-2020
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Provider Business Mailing Address
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Address Line | 7183 PEMBROKE RD
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City | PEMBROKE PINES
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State | FL
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Zip | 33023-2626
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Country | US
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Telephone | 954-981-5455
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Fax | 954-981-2020
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Authorized Official
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Title or Position | OPTICIAN
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Name | MR. MIGUEL E BRINON
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Credential | OPTICIAN
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Telephone | 954-981-5455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | OE 0000037
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License Number State | FL
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