Provider Demographics
NPI:1598351181
Name:HANLEY OPTICAL LLC
Entity Type:Organization
Organization Name:HANLEY OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:904-619-9078
Mailing Address - Street 1:3120 E BANISTER RD
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3028
Mailing Address - Country:US
Mailing Address - Phone:904-619-9078
Mailing Address - Fax:
Practice Address - Street 1:751 OAK ST STE 200
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-3361
Practice Address - Country:US
Practice Address - Phone:904-619-9078
Practice Address - Fax:904-619-9079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty