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General NPI Number Information
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NPI Number | 1629245816
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Entity Type | Organization
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Legal Business Name | GUBER OPTICAL & EYEGLASS BOUTIQUE
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Dates
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Enumeration Date | 05/15/2008
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Last Update Date | 05/15/2008
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Provider Practice Location Address
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Address Line | 501 N ORLANDO AVE SUITE 139
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City | WINTER PARK
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State | FL
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Zip | 32789-7313
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Country | US
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Telephone | 407-644-2211
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Fax | 407-644-1686
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Provider Business Mailing Address
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Address Line | 501 N ORLANDO AVE SUITE 139
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City | WINTER PARK
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State | FL
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Zip | 32789-7313
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSED OPTICIAN/OWNER
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Name | DAVID GUBER
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Credential | L.D.O.
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Telephone | 407-644-2211
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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 | 4511
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License Number State | FL
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