Provider Demographics
NPI:1003866252
Name:DELRAY OPTICAL SERVICE INC
Entity Type:Organization
Organization Name:DELRAY OPTICAL SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:JACOBY
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:561-498-7500
Mailing Address - Street 1:14854 MILITARY TRL
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-8153
Mailing Address - Country:US
Mailing Address - Phone:561-498-7500
Mailing Address - Fax:561-498-7636
Practice Address - Street 1:14854 MILITARY TRL
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-8153
Practice Address - Country:US
Practice Address - Phone:561-498-7500
Practice Address - Fax:561-498-7636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOE 31332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0498020001Medicare NSC