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General NPI Number Information
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NPI Number | 1861545501
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Entity Type | Organization
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Legal Business Name | FOR EYES OPTICAL OF COCONUT GROVE
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 02/27/2020
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Provider Practice Location Address
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Address Line | 2201 E FOWLER AVE STE B
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City | TAMPA
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State | FL
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Zip | 33612-5507
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Country | US
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Telephone | 813-978-1035
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Fax |
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Provider Business Mailing Address
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Address Line | 285 W 74TH PL
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City | HIALEAH
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State | FL
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Zip | 33014-5058
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | KIM GRIFFIN
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Credential |
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Telephone | 305-557-9004
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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 | DO 3754
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License Number State | FL
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