Provider Demographics
NPI:1700816758
Name:BULLSEYE OPTICAL INC
Entity Type:Organization
Organization Name:BULLSEYE OPTICAL INC
Other - Org Name:EYEGLASS FACTORY OUTLET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:IRA
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:954-749-5881
Mailing Address - Street 1:7814A NW 44ST
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351
Mailing Address - Country:US
Mailing Address - Phone:954-749-5881
Mailing Address - Fax:
Practice Address - Street 1:7814A NW 44TH ST
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33351-6206
Practice Address - Country:US
Practice Address - Phone:954-749-5881
Practice Address - Fax:954-572-4822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4372156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1267860001Medicare ID - Type Unspecified