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General NPI Number Information
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NPI Number | 1861664252
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Entity Type | Organization
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Legal Business Name | MINAPA OPTICAL INC
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Dates
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Enumeration Date | 03/26/2008
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 860 S STATE ROAD 7 # 1
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City | WELLINGTON
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State | FL
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Zip | 33414-6266
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Country | US
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Telephone | 561-204-2520
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Fax | 561-204-2524
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Provider Business Mailing Address
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Address Line | 860-1 S STATE ROAD 7
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City | WELLINGTON
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State | FL
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Zip | 33414
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Country | US
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Telephone | 561-204-2520
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Fax | 561-204-2524
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. PAUL TRAK
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Credential |
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Telephone | 561-204-2520
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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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