MEDICARE: LENS SPOT INC I

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

General Provider Information

NPI Number	:	1619144128
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LENS SPOT INC I

Provider Business Mailing Address
First Line	:	8828 W STATE ROAD 84
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33324-4415
Country	:	US
Telephone Number	:	954-916-8484
Fax Number	:

Provider Business Practice Location Address
First Line	:	8828 W STATE ROAD 84
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33324-4415
Country	:	US
Telephone Number	:	954-916-8484
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. LUIS F RODRIGUEZ
Credential	:	OPTICIAN
Telephone Number	:	954-916-8484

Provider Enumeration Date	:	05/14/2008
Last Update Date	:	05/14/2008

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Directions to “LENS SPOT INC I ” Practice Location

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