Provider Demographics
NPI:1629133954
Name:R&E OPTICAL
Entity Type:Organization
Organization Name:R&E OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:COHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-647-7227
Mailing Address - Street 1:260 LOOKOUT PL
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4492
Mailing Address - Country:US
Mailing Address - Phone:407-647-7227
Mailing Address - Fax:407-647-5744
Practice Address - Street 1:260 LOOKOUT PL
Practice Address - Street 2:SUITE 105
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4492
Practice Address - Country:US
Practice Address - Phone:407-647-7227
Practice Address - Fax:407-647-5744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332H00000X332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4424300001Medicare ID - Type Unspecified
FLG13621Medicare UPIN