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General NPI Number Information
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NPI Number | 1891035952
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Entity Type | Organization
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Legal Business Name | BAY STREET OPTICAL INC.
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Dates
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Enumeration Date | 02/26/2013
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Last Update Date | 02/26/2013
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Provider Practice Location Address
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Address Line | 13830 US HIGHWAY 1
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City | SEBASTIAN
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State | FL
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Zip | 32958-3296
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Country | US
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Telephone | 772-589-6222
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Fax |
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Provider Business Mailing Address
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Address Line | 13830 US HIGHWAY 1
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City | SEBASTIAN
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State | FL
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Zip | 32958-3296
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Country | US
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Telephone | 772-589-6222
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. VALERIE BRADY
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Credential |
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Telephone | 772-589-6222
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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 | 1848
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License Number State | FL
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