MEDICARE: DML OPTICAL INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier	1175	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1175	OTHER	FL	MEDICAL LICENSE

General Provider Information

NPI Number	:	1598816738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DML OPTICAL INC

Provider Business Mailing Address
First Line	:	3435 49TH ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33710-2147
Country	:	US
Telephone Number	:	727-522-8423
Fax Number	:	727-521-1886

Provider Business Practice Location Address
First Line	:	3455 49TH ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33710-2147
Country	:	US
Telephone Number	:	727-522-8423
Fax Number	:	727-521-1886

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LYNDA K FLOOD
Credential	:	LOO
Telephone Number	:	727-522-8423

Provider Enumeration Date	:	01/15/2007
Last Update Date	:	07/09/2008

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Directions to “DML OPTICAL INC ” Practice Location

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