Provider Demographics
NPI:1548572571
Name:FLORIDA OPTICAL ENTERPRISES, INC.
Entity Type:Organization
Organization Name:FLORIDA OPTICAL ENTERPRISES, INC.
Other - Org Name:NONE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LATCHMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDOWAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-343-0567
Mailing Address - Street 1:1011 W VINE ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4166
Mailing Address - Country:US
Mailing Address - Phone:407-343-0567
Mailing Address - Fax:407-944-1030
Practice Address - Street 1:1011 W VINE ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4166
Practice Address - Country:US
Practice Address - Phone:407-343-0567
Practice Address - Fax:407-944-1030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-07
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3905152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1184944985Medicaid