Provider Demographics
NPI:1588614663
Name:GILBERT, MAURICE WILLIAM (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:MAURICE
Middle Name:WILLIAM
Last Name:GILBERT
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RUSH OPTICAL, INC
Mailing Address - Street 2:1644 NE 164 STREET
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-4017
Mailing Address - Country:US
Mailing Address - Phone:305-945-3615
Mailing Address - Fax:305-940-2065
Practice Address - Street 1:1644 NE 164TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4017
Practice Address - Country:US
Practice Address - Phone:305-945-3615
Practice Address - Fax:305-940-2065
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO 0002672156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL086866300Medicaid
FL0557300001Medicare NSC