Provider Demographics
NPI:1376302679
Name:OPTICAL EXPERIENCE LLC
Entity Type:Organization
Organization Name:OPTICAL EXPERIENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DESTYNEE
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:561-401-0902
Mailing Address - Street 1:218 LYMAN PL
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-3708
Mailing Address - Country:US
Mailing Address - Phone:561-566-0830
Mailing Address - Fax:561-203-1692
Practice Address - Street 1:5601 CORPORATE WAY STE 117
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2041
Practice Address - Country:US
Practice Address - Phone:561-401-0902
Practice Address - Fax:561-203-1692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier