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General NPI Number Information
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NPI Number | 1609498856
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Entity Type | Organization
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Legal Business Name | OPTIMAL VISION OPTOMETRY LLC
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Dates
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Enumeration Date | 05/11/2020
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Last Update Date | 03/29/2021
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Provider Practice Location Address
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Address Line | 11841 PALM BEACH BLVD UNIT 117
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City | FORT MYERS
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State | FL
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Zip | 33905-5914
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Country | US
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Telephone | 239-500-2020
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Fax | 239-500-2030
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Provider Business Mailing Address
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Address Line | 11841 PALM BEACH BLVD UNIT 117
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City | FORT MYERS
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State | FL
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Zip | 33905-5914
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Country | US
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Telephone | 239-500-2020
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Fax | 239-500-2030
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Authorized Official
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Title or Position | MGRM
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Name | BRITTANY ANN DEGLER
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Credential | OD
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Telephone | 239-500-2020
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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 |
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License Number State |
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