Provider Demographics
NPI:1497139885
Name:VOLUSIA OPTICAL, L.L.C.
Entity Type:Organization
Organization Name:VOLUSIA OPTICAL, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HETHER
Authorized Official - Middle Name:
Authorized Official - Last Name:BUHLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-734-2931
Mailing Address - Street 1:1592 S SR 15A
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-7786
Mailing Address - Country:US
Mailing Address - Phone:386-734-2931
Mailing Address - Fax:386-734-2939
Practice Address - Street 1:975 TOWN CENTER DR
Practice Address - Street 2:STE. 200
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8269
Practice Address - Country:US
Practice Address - Phone:386-774-6109
Practice Address - Fax:386-917-0584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier