Provider Demographics
NPI:1477235752
Name:TREASURE FORD OPTICS
Entity Type:Organization
Organization Name:TREASURE FORD OPTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHELLNELL
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTIFORD
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:754-224-0594
Mailing Address - Street 1:4239 W COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33319-3305
Mailing Address - Country:US
Mailing Address - Phone:754-202-5505
Mailing Address - Fax:
Practice Address - Street 1:4239 W COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319-3305
Practice Address - Country:US
Practice Address - Phone:754-202-5505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty