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General NPI Number Information
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NPI Number | 1871768879
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE OPTICAL DESIGNS
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Dates
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Enumeration Date | 04/29/2008
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Last Update Date | 04/29/2008
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Provider Practice Location Address
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Address Line | 21178 OLEAN BLVD SUITE B
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-6728
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Country | US
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Telephone | 941-629-1211
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Fax |
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Provider Business Mailing Address
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Address Line | 21178 OLEAN BLVD SUITE B
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-6728
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Country | US
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Telephone | 941-629-1211
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | CRAIG CZYZ
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Credential | D.O.
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Telephone | 941-629-1211
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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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