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General NPI Number Information
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NPI Number | 1699851600
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Entity Type | Organization
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Legal Business Name | FOR EYES OPTICAL OF PENNSYLVANIA
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 02/21/2020
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Provider Practice Location Address
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Address Line | 1847 SOUTH PARK BLVD
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City | COLONIAL HEIGHTS
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State | VA
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Zip | 23834
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Country | US
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Telephone | 804-526-3591
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Fax | 804-526-3597
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Provider Business Mailing Address
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Address Line | 3601 SW 160TH AVE STE 400
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City | MIRAMAR
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State | FL
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Zip | 33027-6312
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Country | US
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Telephone | 305-557-9004
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | KIM GRIFFIN
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Credential |
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Telephone | 305-557-9004
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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 |
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License Number State |
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