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General NPI Number Information
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NPI Number | 1861690828
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Entity Type | Organization
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Legal Business Name | OPTISAVE INC
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 02/26/2009
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Provider Practice Location Address
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Address Line | 410 W TENNESSEE ST
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City | TALLAHASSEE
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State | FL
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Zip | 32301-1026
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Country | US
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Telephone | 850-561-5030
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Fax | 850-561-0770
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Provider Business Mailing Address
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Address Line | 410 W TENNESSEE ST
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City | TALLAHASSEE
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State | FL
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Zip | 32301-1026
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Country | US
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Telephone | 850-561-5030
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Fax | 850-561-0770
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Authorized Official
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Title or Position | OWNER
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Name | DR. KAREN DORA DETWILER
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Credential | O.D.
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Telephone | 850-561-5030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OP1733
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License Number State | FL
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