Provider Demographics
NPI:1255504858
Name:EYE Q INC
Entity Type:Organization
Organization Name:EYE Q INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:WOLMETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-477-9955
Mailing Address - Street 1:10156 LEXINGTON ESTATES BLVD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-4256
Mailing Address - Country:US
Mailing Address - Phone:561-477-9955
Mailing Address - Fax:561-470-3601
Practice Address - Street 1:6486 LAKE WORTH RD
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-3008
Practice Address - Country:US
Practice Address - Phone:561-968-4942
Practice Address - Fax:561-721-0714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-04
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL152W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL086553200Medicaid
FL0954180001Medicare NSC