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General NPI Number Information
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NPI Number | 1770582835
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Entity Type | Organization
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Legal Business Name | COMMUNITY EYE OPTICAL LC
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Dates
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Enumeration Date | 07/20/2005
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Last Update Date | 05/02/2016
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Provider Practice Location Address
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Address Line | 21275 OLEAN BLVD
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-6704
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Country | US
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Telephone | 941-625-1960
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Fax | 941-625-5780
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Provider Business Mailing Address
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Address Line | 21275 OLEAN BLVD
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-6704
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Country | US
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Telephone | 941-625-1960
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Fax | 941-625-5780
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | DR. ERIC R SCHAIBLE
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Credential | M.D.
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Telephone | 941-625-1325
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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 | 79133
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License Number State | FL
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