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General NPI Number Information
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NPI Number | 1649441981
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Entity Type | Organization
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Legal Business Name | COCONUT CREEK OPTICAL INC.
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Dates
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Enumeration Date | 03/14/2008
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Last Update Date | 03/09/2017
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Provider Practice Location Address
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Address Line | 5351 LYONS RD
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City | COCONUT CREEK
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State | FL
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Zip | 33073-2825
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Country | US
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Telephone | 954-975-0009
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Fax | 954-975-0416
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Provider Business Mailing Address
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Address Line | 5351 LYONS RD
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City | COCONUT CREEK
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State | FL
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Zip | 33073-2825
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Country | US
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Telephone | 954-975-0009
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Fax | 954-975-0416
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Authorized Official
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Title or Position | OPTICIAN
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Name | ROBERT GOLDSMITH
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Credential |
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Telephone | 954-975-0009
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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 | FL1722
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License Number State | FL
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