Provider Demographics
NPI:1851658264
Name:OPTICAL BY THE SEA, INC.
Entity Type:Organization
Organization Name:OPTICAL BY THE SEA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:EDONAIS
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:954-491-5818
Mailing Address - Street 1:235 EAST COMMERCIAL BLVD. SUITE # 103
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE BY THE SEA
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4430
Mailing Address - Country:US
Mailing Address - Phone:954-491-5818
Mailing Address - Fax:954-491-5819
Practice Address - Street 1:235 EAST COMMERCIAL BLVD. SUITE # 103
Practice Address - Street 2:
Practice Address - City:LAUDERDALE BY THE SEA
Practice Address - State:FL
Practice Address - Zip Code:33308-4430
Practice Address - Country:US
Practice Address - Phone:954-491-5818
Practice Address - Fax:954-491-5819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO-3073156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty