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General NPI Number Information
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NPI Number | 1801113725
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Entity Type | Organization
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Legal Business Name | METRO MEDICAL PLAZA OPTICAL
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Dates
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Enumeration Date | 05/02/2010
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Last Update Date | 05/02/2010
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Provider Practice Location Address
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Address Line | 13691 METRO PKWY SUITE 100
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City | FORT MYERS
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State | FL
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Zip | 33912-4327
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Country | US
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Telephone | 239-334-2015
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Fax | 239-936-0047
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Provider Business Mailing Address
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Address Line | 13691 METRO PKWY SUITE 100
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City | FORT MYERS
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State | FL
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Zip | 33912-4327
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Country | US
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Telephone | 239-334-2015
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Fax | 239-936-0047
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Authorized Official
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Title or Position | LICENSED OPTICIAN
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Name | MR. DANIEL GUILLERMO ACOSTA
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Credential | L.D.O.
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Telephone | 239-334-2015
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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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