Provider Demographics
NPI:1578549259
Name:WORLD OPTICAL II INC
Entity Type:Organization
Organization Name:WORLD OPTICAL II INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUSK
Authorized Official - Middle Name:S
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-916-8484
Mailing Address - Street 1:8828 W STATE ROAD 84
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-4415
Mailing Address - Country:US
Mailing Address - Phone:954-916-8484
Mailing Address - Fax:954-476-2668
Practice Address - Street 1:8828 W STATE ROAD 84
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-4415
Practice Address - Country:US
Practice Address - Phone:954-916-8484
Practice Address - Fax:954-476-2668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL920528784811OtherCCN
FL620562801Medicaid
FL620092302Medicaid
FL3184 DMedicare ID - Type UnspecifiedINDIVIDUAL / KAREN MEMOLI
FL20612 ZMedicare ID - Type UnspecifiedINDIVIDUAL/ RUSK HARRIS
FL620562801Medicaid
FL920528784811OtherCCN
FL620092302Medicaid