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General NPI Number Information
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NPI Number | 1982621884
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Entity Type | Organization
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Legal Business Name | ECSA OPTICAL COMPANY, LLC
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Dates
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Enumeration Date | 07/16/2006
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Last Update Date | 10/08/2012
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Provider Practice Location Address
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Address Line | 1400 US HIGHWAY 1 S
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City | ST AUGUSTINE
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State | FL
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Zip | 32084-4211
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Country | US
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Telephone | 904-829-2286
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Fax | 904-829-5447
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Provider Business Mailing Address
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Address Line | 1400 US HIGHWAY 1 S
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City | ST AUGUSTINE
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State | FL
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Zip | 32084-4211
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Country | US
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Telephone | 904-829-2286
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Fax | 904-829-5447
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Authorized Official
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Title or Position | MANAGER
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Name | PAUL W HUND III
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Credential | MD
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Telephone | 904-829-2286
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | ME68633
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License Number State | FL
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