Provider Demographics
NPI:1306856687
Name:NORMA L. GARY
Entity Type:Organization
Organization Name:NORMA L. GARY
Other - Org Name:LINGERIE BOUTIQUE BY NORMA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/CERTIFIED MASTECTOMY FITTER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:GARY
Authorized Official - Suffix:
Authorized Official - Credentials:ABC CERTIFICATION
Authorized Official - Phone:352-347-7855
Mailing Address - Street 1:16770 S US 441
Mailing Address - Street 2:STE 601
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491
Mailing Address - Country:US
Mailing Address - Phone:352-347-7855
Mailing Address - Fax:352-347-7856
Practice Address - Street 1:16770 S US 441
Practice Address - Street 2:STE 601
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491
Practice Address - Country:US
Practice Address - Phone:352-347-7855
Practice Address - Fax:352-347-7856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR6320OtherBCBS
FLR6320OtherBCBS
FL0986450001Medicare NSC