Provider Demographics
NPI:1609169986
Name:BELLA OPTICAL, INC.
Entity Type:Organization
Organization Name:BELLA OPTICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROSSIQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-617-5988
Mailing Address - Street 1:2618 BOGGY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-4112
Mailing Address - Country:US
Mailing Address - Phone:407-624-4508
Mailing Address - Fax:
Practice Address - Street 1:2618 BOGGY CREEK RD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-4112
Practice Address - Country:US
Practice Address - Phone:407-624-4508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOE 1985302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization