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General NPI Number Information
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NPI Number | 1609075019
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Entity Type | Organization
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Legal Business Name | EYE-WEAR GLASSES III INC
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Dates
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Enumeration Date | 07/16/2007
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Last Update Date | 02/01/2008
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Provider Practice Location Address
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Address Line | 122 W PALMETTO PARK RD
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City | BOCA RATON
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State | FL
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Zip | 33432
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Country | US
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Telephone | 561-368-5844
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Fax | 561-368-6681
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Provider Business Mailing Address
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Address Line | 122 W PALMETTO PARK RD
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City | BOCA RATON
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State | FL
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Zip | 33432-3828
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Country | US
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Telephone | 561-368-5844
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Fax | 561-368-6681
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RICHARD M MANDEL
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Credential |
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Telephone | 561-368-5844
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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 | 1112
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License Number State | FL
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