Provider Demographics
NPI:1346432044
Name:VANBUSKIRK OPTICIANS
Entity Type:Organization
Organization Name:VANBUSKIRK OPTICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:M
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:VANBUSKIRK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-649-1011
Mailing Address - Street 1:798 NEAPOLITAN WAY
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-8504
Mailing Address - Country:US
Mailing Address - Phone:239-649-1011
Mailing Address - Fax:239-649-7752
Practice Address - Street 1:798 NEAPOLITAN WAY
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-8504
Practice Address - Country:US
Practice Address - Phone:239-649-1011
Practice Address - Fax:239-649-7752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDE0000110332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0680190002Medicare NSC