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General NPI Number Information
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NPI Number | 1891969804
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Entity Type | Organization
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Legal Business Name | STANLEYS CUSTOM EYEWEAR INC
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Dates
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Enumeration Date | 04/22/2008
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Last Update Date | 04/26/2022
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Provider Practice Location Address
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Address Line | 6380 N LOCKWOOD RIDGE RD
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City | SARASOTA
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State | FL
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Zip | 34243-2531
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Country | US
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Telephone | 941-351-7744
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Fax | 941-351-9839
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Provider Business Mailing Address
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Address Line | 6380 N LOCKWOOD RIDGE RD
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City | SARASOTA
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State | FL
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Zip | 34243-2531
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Country | US
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Telephone | 941-351-7744
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Fax | 941-351-9839
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. STANLEY E WOOTEN
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Credential | CERTIFIED OPTICIAN
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Telephone | 941-351-7744
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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 | 2760
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License Number State | FL
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