Provider Demographics
NPI:1417159492
Name:FLAMINGO ISLAND OPTICIANS INC
Entity Type:Organization
Organization Name:FLAMINGO ISLAND OPTICIANS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:239-565-6342
Mailing Address - Street 1:11061 CHAMPIONSHIP DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-8125
Mailing Address - Country:US
Mailing Address - Phone:239-565-6342
Mailing Address - Fax:
Practice Address - Street 1:11902 BONITA BEACH RD SE # 9-10B
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-5913
Practice Address - Country:US
Practice Address - Phone:239-565-6342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO4769156FX1800X
FLOE1318332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Not Answered332H00000XSuppliersEyewear Supplier