Provider Demographics
NPI:1467908228
Name:CENTRAL FLORIDA OPTICAL, LLC
Entity Type:Organization
Organization Name:CENTRAL FLORIDA OPTICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:STUART
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:407-896-8990
Mailing Address - Street 1:1900 N ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-5531
Mailing Address - Country:US
Mailing Address - Phone:407-896-8990
Mailing Address - Fax:407-896-6034
Practice Address - Street 1:1900 N ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-5531
Practice Address - Country:US
Practice Address - Phone:407-896-8990
Practice Address - Fax:407-896-6034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO6032156FC0801X, 156FX1800X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens FitterGroup - Single Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty