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General NPI Number Information
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NPI Number | 1780406264
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Entity Type | Organization
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Legal Business Name | INTO THE LOOKING GLASSES, LLC
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Dates
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Enumeration Date | 10/28/2024
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 1845 TOWN CENTER BLVD STE 100
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City | FLEMING ISLAND
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State | FL
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Zip | 32003-3358
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Country | US
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Telephone | 904-579-4722
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Fax |
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Provider Business Mailing Address
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Address Line | 1845 TOWN CENTER BLVD STE 100
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City | FLEMING ISLAND
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State | FL
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Zip | 32003-3358
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Country | US
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Telephone | 904-579-4722
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Fax |
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Authorized Official
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Title or Position | OWNER/OPTICIAN
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Name | MRS. AMANDA K MONKOSKI
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Credential | LDO
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Telephone | 904-579-4722
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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 |
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License Number State |
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