Provider Demographics
NPI:1558847608
Name:PUBLIC EYE OPTICAL, PA
Entity Type:Organization
Organization Name:PUBLIC EYE OPTICAL, PA
Other - Org Name:PUBLIC EYE OPTICAL, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:419-215-7696
Mailing Address - Street 1:1504 BAY RD APT 1515
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-3275
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:537 SW 12TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-2413
Practice Address - Country:US
Practice Address - Phone:419-215-7696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PUBLIC EYE OPTICAL, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty