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General NPI Number Information
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NPI Number | 1922294966
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Entity Type | Organization
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Legal Business Name | CRYSTAL EYES OPTICAL, LLC
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Dates
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Enumeration Date | 09/24/2007
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Last Update Date | 09/24/2007
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Provider Practice Location Address
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Address Line | 4165 9TH ST SW SUITE 106
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City | VERO BEACH
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State | FL
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Zip | 32968-4878
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Country | US
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Telephone | 772-978-1172
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Fax | 772-978-1173
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Provider Business Mailing Address
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Address Line | 4165 9TH ST SW SUITE 106
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City | VERO BEACH
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State | FL
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Zip | 32968-4878
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Country | US
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Telephone | 772-978-1172
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Fax | 772-978-1173
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MR. CHARLESS SESSIONS
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Credential | LICENSED OPTICIAN
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Telephone | 772-978-1172
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | DO5603
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License Number State | FL
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