Provider Demographics
NPI:1922192368
Name:AMYX OPTICAL INC DBA HILLMOOR OPTICAL
Entity Type:Organization
Organization Name:AMYX OPTICAL INC DBA HILLMOOR OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AMYX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-337-6377
Mailing Address - Street 1:8958 S. US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-3403
Mailing Address - Country:US
Mailing Address - Phone:772-337-6377
Mailing Address - Fax:772-337-9177
Practice Address - Street 1:8958 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-3403
Practice Address - Country:US
Practice Address - Phone:772-337-6377
Practice Address - Fax:772-337-9177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL630358700Medicaid
FL5341900001Medicare ID - Type Unspecified