Provider Demographics
NPI:1477729416
Name:FLORIDA EYEGLASS CORPORATION
Entity Type:Organization
Organization Name:FLORIDA EYEGLASS CORPORATION
Other - Org Name:EYEGLASS EXPRESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:T
Authorized Official - Last Name:FLATER
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:352-332-3937
Mailing Address - Street 1:1132 NW 76TH BLVD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6749
Mailing Address - Country:US
Mailing Address - Phone:352-332-3937
Mailing Address - Fax:352-332-0435
Practice Address - Street 1:1132 NW 76TH BLVD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6749
Practice Address - Country:US
Practice Address - Phone:352-332-3937
Practice Address - Fax:352-332-0435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0889950001Medicare NSC