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General NPI Number Information
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NPI Number | 1720100399
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Entity Type | Organization
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Legal Business Name | P D LAB INC
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 08/02/2010
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Provider Practice Location Address
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Address Line | 6169 JOG RD STE A3
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City | LAKE WORTH
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State | FL
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Zip | 33467-6579
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Country | US
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Telephone | 561-304-1234
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Fax | 561-304-1254
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Provider Business Mailing Address
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Address Line | 6169 JOG RD STE A3
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City | LAKE WORTH
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State | FL
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Zip | 33467-6579
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Country | US
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Telephone | 561-304-1234
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Fax | 561-304-1254
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Authorized Official
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Title or Position | PRESIDENT OPTICIAN
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Name | MR. PETER FOX
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Credential |
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Telephone | 561-304-1234
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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 | DO1062
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License Number State | FL
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