| |
7775 N Wickham Rd, Melbourne, FL 32940-7914 | |
(321) 984-3200 | |
(321) 255-1141 |
Full Name | |
---|---|
Type | Facility |
Speciality | Eyewear Supplier |
Location | 7775 N Wickham Rd, Melbourne, Florida |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1548484066 | NPI | - | NPPES |
1558456681 | Other | NPI GROUP | |
1619915105 | Other | NPI MINTCHELL | |
252338806 | Medicaid | FL | |
1003075730 | Other | NPI DELATORRE | |
086944909 | Medicaid | FL | |
1477503696 | Other | NPI TRES | |
1942346911 | Other | NPI REYNOLDS | |
0539980004 | Other | DEMERC ST |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (* (Not Available)) | Secondary |
332H00000X | Eyewear Supplier | (* (Not Available)) | Primary |
Mailing Address | Practice Location Address |
---|---|
665 S Apollo Blvd, Melbourne, FL 32901-1485 Ph: (321) 984-3200 | 7775 N Wickham Rd, Melbourne, FL 32940-7914 Ph: (321) 984-3200 |