Provider Demographics
NPI:1235218876
Name:KENDALL OPTICAL CENTER, INC
Entity Type:Organization
Organization Name:KENDALL OPTICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:305-670-6060
Mailing Address - Street 1:7400 N KENDALL DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7706
Mailing Address - Country:US
Mailing Address - Phone:305-670-6060
Mailing Address - Fax:305-670-0678
Practice Address - Street 1:7400 N KENDALL DR
Practice Address - Street 2:SUITE 110
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7706
Practice Address - Country:US
Practice Address - Phone:305-670-6060
Practice Address - Fax:305-670-0678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOE-0000432332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0478990001Medicare NSC