Provider Demographics
NPI:1629245816
Name:GUBER OPTICAL & EYEGLASS BOUTIQUE
Entity Type:Organization
Organization Name:GUBER OPTICAL & EYEGLASS BOUTIQUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED OPTICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GUBER
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:407-644-2211
Mailing Address - Street 1:501 N ORLANDO AVE
Mailing Address - Street 2:SUITE 139
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-7313
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 N ORLANDO AVE
Practice Address - Street 2:SUITE 139
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-7313
Practice Address - Country:US
Practice Address - Phone:407-644-2211
Practice Address - Fax:407-644-1686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4511332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier