Provider Demographics
NPI:1457494486
Name:FAMOUSPEOPLESEYEWEARANDKIDZBIZINC
Entity Type:Organization
Organization Name:FAMOUSPEOPLESEYEWEARANDKIDZBIZINC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:BARBARA
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:813-737-1122
Mailing Address - Street 1:PO BOX 240
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-0240
Mailing Address - Country:US
Mailing Address - Phone:813-737-1122
Mailing Address - Fax:813-737-1102
Practice Address - Street 1:10423 CR39
Practice Address - Street 2:
Practice Address - City:LITHIA
Practice Address - State:FL
Practice Address - Zip Code:33547-2864
Practice Address - Country:US
Practice Address - Phone:813-737-1122
Practice Address - Fax:813-737-1102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO2694156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty