Provider Demographics
NPI:1326343831
Name:ABSOLUTELY OPTICAL
Entity Type:Organization
Organization Name:ABSOLUTELY OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:813-348-9696
Mailing Address - Street 1:2223 N WEST SHORE BLVD
Mailing Address - Street 2:STE 169B
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-1411
Mailing Address - Country:US
Mailing Address - Phone:813-348-9696
Mailing Address - Fax:813-398-0660
Practice Address - Street 1:2223 N WEST SHORE BLVD
Practice Address - Street 2:STE 169B
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-1411
Practice Address - Country:US
Practice Address - Phone:813-348-9696
Practice Address - Fax:813-398-0660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1789332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLEI120AMedicare PIN