Provider Demographics
NPI:1568646214
Name:S & O EYEGLASS GALLERIA
Entity Type:Organization
Organization Name:S & O EYEGLASS GALLERIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:OBERLENDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-892-2020
Mailing Address - Street 1:12559A BISCAYNE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-2522
Mailing Address - Country:US
Mailing Address - Phone:305-892-2020
Mailing Address - Fax:
Practice Address - Street 1:12559A BISCAYNE BLVD
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-2522
Practice Address - Country:US
Practice Address - Phone:305-892-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO958156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4574630001Medicare NSC