Provider Demographics
NPI:1467502658
Name:OPTICAL IMPRESSIONS
Entity Type:Organization
Organization Name:OPTICAL IMPRESSIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:D'ONOFRIO
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:954-433-4770
Mailing Address - Street 1:2605 N HIATUS RD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33026-1303
Mailing Address - Country:US
Mailing Address - Phone:954-443-4266
Mailing Address - Fax:954-443-4266
Practice Address - Street 1:2605 N HIATUS RD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33026-1303
Practice Address - Country:US
Practice Address - Phone:954-443-4266
Practice Address - Fax:954-443-4266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO 2314156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0835130001Medicare ID - Type UnspecifiedDURABLE MEDICAL SUPPLIES