Provider Demographics
NPI:1346423902
Name:EYEWEAR CENTER OF FLAGLER COUNTY INC.
Entity Type:Organization
Organization Name:EYEWEAR CENTER OF FLAGLER COUNTY INC.
Other - Org Name:CRAIG'S EYEWEAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MASTER OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-446-2020
Mailing Address - Street 1:50 CYPRESS POINT PKWY
Mailing Address - Street 2:SUITE C3-4
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-2500
Mailing Address - Country:US
Mailing Address - Phone:386-446-2020
Mailing Address - Fax:386-446-6098
Practice Address - Street 1:50 CYPRESS POINT PKWY
Practice Address - Street 2:SUITE C3-4
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-2500
Practice Address - Country:US
Practice Address - Phone:386-446-2020
Practice Address - Fax:386-446-6098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO1099332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1016220001Medicare NSC