Provider Demographics
NPI:1003837212
Name:EYESAVERS OPTICAL INC
Entity Type:Organization
Organization Name:EYESAVERS OPTICAL INC
Other - Org Name:29/49 EYESAVERS OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ARON
Authorized Official - Middle Name:M
Authorized Official - Last Name:ARKON
Authorized Official - Suffix:
Authorized Official - Credentials:LIC OPTICIAN
Authorized Official - Phone:727-846-0823
Mailing Address - Street 1:4126 US HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-5947
Mailing Address - Country:US
Mailing Address - Phone:727-846-0823
Mailing Address - Fax:727-846-0823
Practice Address - Street 1:4126 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-5947
Practice Address - Country:US
Practice Address - Phone:727-846-0823
Practice Address - Fax:727-846-0823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL630187800Medicaid