| |
1270 Saxon Blvd, Suite 105, Orange City, FL 32763-8418 | |
(386) 774-5000 | |
(386) 774-0444 |
Full Name | |
---|---|
Type | Facility |
Speciality | Eyewear Supplier |
Location | 1270 Saxon Blvd, Orange City, Florida |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1184904260 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 2732 (Florida) | Secondary |
332H00000X | Eyewear Supplier | OE 2002 (Florida) | Primary |
332H00000X | Eyewear Supplier | DO 5119 (Florida) | Secondary |
Mailing Address | Practice Location Address |
---|---|
1270 Saxon Blvd, Suite 105, Orange City, FL 32763-8418 Ph: (386) 774-5000 | 1270 Saxon Blvd, Suite 105, Orange City, FL 32763-8418 Ph: (386) 774-5000 |