Provider Demographics
NPI:1235309154
Name:BK OPTICAL INC
Entity Type:Organization
Organization Name:BK OPTICAL INC
Other - Org Name:EYEGLASSWORKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENCSCED DISPENSING OPTITION
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMEY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KARR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:239-573-6100
Mailing Address - Street 1:523 SW PINE ISLAND RD UNIT 107
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991-1966
Mailing Address - Country:US
Mailing Address - Phone:239-573-6100
Mailing Address - Fax:239-573-6125
Practice Address - Street 1:523 SW PINE ISLAND RD UNIT 107
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-1966
Practice Address - Country:US
Practice Address - Phone:239-573-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOE 1642332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier