Provider Demographics
NPI:1295856516
Name:UNIVERSITY OPTICIANS, INC.
Entity Type:Organization
Organization Name:UNIVERSITY OPTICIANS, INC.
Other - Org Name:UNIVERSITY OPTICFIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDRIK
Authorized Official - Middle Name:D
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:352-378-4480
Mailing Address - Street 1:300 SW 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-6550
Mailing Address - Country:US
Mailing Address - Phone:352-378-4480
Mailing Address - Fax:352-377-5710
Practice Address - Street 1:300 SW 4TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-6550
Practice Address - Country:US
Practice Address - Phone:352-378-4480
Practice Address - Fax:352-377-5710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0011225156FX1100X
FLOE0000041156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmicGroup - Multi-Specialty
Not Answered156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD5278Medicare ID - Type Unspecified