Provider Demographics
NPI:1184825853
Name:GAINESVILLE OPTICIANS II, LLC
Entity Type:Organization
Organization Name:GAINESVILLE OPTICIANS II, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER OPTICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DURRANCE
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:352-271-3338
Mailing Address - Street 1:2015 NW 43RD ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-3481
Mailing Address - Country:US
Mailing Address - Phone:352-271-3338
Mailing Address - Fax:352-271-3353
Practice Address - Street 1:2015 NW 43RD ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-3481
Practice Address - Country:US
Practice Address - Phone:352-271-3338
Practice Address - Fax:352-271-3353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO4464332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4933640001Medicare ID - Type UnspecifiedSUPPLIER PROVIDER NUMBER