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General NPI Number Information
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NPI Number | 1801073416
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Entity Type | Organization
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Legal Business Name | CHARLOTTE OPTICAL INC
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Dates
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Enumeration Date | 01/25/2008
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Last Update Date | 05/05/2011
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Provider Practice Location Address
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Address Line | 18401 MURDOCK CIR SUITE A
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City | PORT CHARLOTTE
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State | FL
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Zip | 33948-1026
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Country | US
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Telephone | 941-625-9077
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Fax | 941-258-9078
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Provider Business Mailing Address
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Address Line | 18401 MURDOCK CIR SUITE A
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City | PORT CHARLOTTE
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State | FL
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Zip | 33948-1026
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Country | US
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Telephone | 941-625-9077
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Fax | 941-625-9077
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Authorized Official
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Title or Position | OWNER
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Name | MR. MURIEL NASH
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Credential |
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Telephone | 941-625-9077
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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 | 2032193
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License Number State | FL
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