Provider Demographics
NPI:1720208473
Name:LOLY'S OPTICAL INC
Entity Type:Organization
Organization Name:LOLY'S OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOLORES
Authorized Official - Middle Name:CARMEN
Authorized Official - Last Name:MACEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-446-8220
Mailing Address - Street 1:3727 SW 8TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-3158
Mailing Address - Country:US
Mailing Address - Phone:305-446-8220
Mailing Address - Fax:305-445-6903
Practice Address - Street 1:3727 SW 8TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-3158
Practice Address - Country:US
Practice Address - Phone:305-446-8220
Practice Address - Fax:305-445-6903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2566332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL086354800Medicaid