Provider Demographics
NPI:1417130360
Name:OPTICAL FACTORY AND SHOWROOM INC
Entity Type:Organization
Organization Name:OPTICAL FACTORY AND SHOWROOM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KARA
Authorized Official - Middle Name:S
Authorized Official - Last Name:COLECCHIA
Authorized Official - Suffix:
Authorized Official - Credentials:LDO 3570
Authorized Official - Phone:727-585-8521
Mailing Address - Street 1:800 E BAY DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-2553
Mailing Address - Country:US
Mailing Address - Phone:727-585-8521
Mailing Address - Fax:727-584-1973
Practice Address - Street 1:800 E BAY DR
Practice Address - Street 2:SUITE G
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-2553
Practice Address - Country:US
Practice Address - Phone:727-585-8521
Practice Address - Fax:727-584-1973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOE 0000082332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0537760001Medicare NSC