Provider Demographics
NPI:1609498856
Name:OPTIMAL VISION OPTOMETRY LLC
Entity Type:Organization
Organization Name:OPTIMAL VISION OPTOMETRY LLC
Other - Org Name:RIVERSIDE FAMILY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DEGLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:239-500-2020
Mailing Address - Street 1:11841 PALM BEACH BLVD UNIT 117
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-5914
Mailing Address - Country:US
Mailing Address - Phone:239-500-2020
Mailing Address - Fax:239-500-2030
Practice Address - Street 1:11841 PALM BEACH BLVD UNIT 117
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-5914
Practice Address - Country:US
Practice Address - Phone:239-500-2020
Practice Address - Fax:239-500-2030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-11
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty