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General NPI Number Information
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NPI Number | 1992839443
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Entity Type | Organization
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Legal Business Name | OSCEOLA OPTIQUE
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 12/04/2008
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Provider Practice Location Address
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Address Line | 3201 NE SKYLINE DR SUITE D
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City | JENSEN BEACH
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State | FL
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Zip | 34957-3912
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Country | US
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Telephone | 772-334-4264
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Fax | 772-334-4265
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Provider Business Mailing Address
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Address Line | 3201 NE SKYLINE DR SUITE D
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City | JENSEN BEACH
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State | FL
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Zip | 34957-3912
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Country | US
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Telephone | 772-334-4264
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Fax | 772-334-4265
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEWELL RENEE CHANG
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Credential | OD
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Telephone | 772-334-4264
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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 | OPC2950
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License Number State | FL
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