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General NPI Number Information
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NPI Number | 1699826552
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Entity Type | Organization
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Legal Business Name | EYE-STYLE OPTICAL
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7 OLD KINGS RD N STE 32
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City | PALM COAST
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State | FL
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Zip | 32137-8247
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Country | US
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Telephone | 386-446-4210
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Fax | 386-445-7309
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Provider Business Mailing Address
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Address Line | 7 OLD KINGS RD N STE 32
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City | PALM COAST
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State | FL
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Zip | 32137-8247
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Country | US
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Telephone | 386-446-4210
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Fax | 386-445-7309
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Authorized Official
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Title or Position | OWNER
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Name | JADE JACKSON
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Credential | L.D.O
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Telephone | 386-446-4210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | DO3668
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License Number State | FL
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