Provider Demographics
NPI:1851695076
Name:GOOGLY EYES, INC
Entity Type:Organization
Organization Name:GOOGLY EYES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:321-454-4800
Mailing Address - Street 1:777 E MERRITT ISLAND CSWY
Mailing Address - Street 2:STE 221
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-3576
Mailing Address - Country:US
Mailing Address - Phone:321-454-4800
Mailing Address - Fax:321-454-2019
Practice Address - Street 1:777 E MERRITT ISLAND CSWY
Practice Address - Street 2:STE 221
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-3576
Practice Address - Country:US
Practice Address - Phone:321-454-4800
Practice Address - Fax:321-454-2019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4319152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty