Provider Demographics
NPI:1205027828
Name:STYLE SITE OPTICAL INC
Entity Type:Organization
Organization Name:STYLE SITE OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:ELBRAND
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:305-935-5250
Mailing Address - Street 1:19013 BISCAYNE BLVD
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2819
Mailing Address - Country:US
Mailing Address - Phone:305-935-5250
Mailing Address - Fax:305-935-5250
Practice Address - Street 1:19013 BISCAYNE BLVD
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-2819
Practice Address - Country:US
Practice Address - Phone:305-935-5250
Practice Address - Fax:305-935-5250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL086702101Medicaid
FL0591310001Medicare NSC