Provider Demographics
NPI:1760707921
Name:HUNT CLUB OPTICAL
Entity Type:Organization
Organization Name:HUNT CLUB OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:CLARKE
Authorized Official - Middle Name:MERRILL
Authorized Official - Last Name:GLATT
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED OPTICIAN #1
Authorized Official - Phone:407-862-2020
Mailing Address - Street 1:612 SOUTH HUNT CLUB BLVD.
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-4958
Mailing Address - Country:US
Mailing Address - Phone:407-862-2020
Mailing Address - Fax:407-862-6730
Practice Address - Street 1:612 SOUTH HUNT CLUB BLVD.
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-4958
Practice Address - Country:US
Practice Address - Phone:407-862-2020
Practice Address - Fax:407-862-6730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1580156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty