Provider Demographics
NPI:1922212786
Name:EYE CARE OPTICAL CENTER, INC.
Entity Type:Organization
Organization Name:EYE CARE OPTICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HESSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO 1747
Authorized Official - Phone:305-665-2353
Mailing Address - Street 1:7300 SW 57 AVENUE
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143
Mailing Address - Country:US
Mailing Address - Phone:305-665-2353
Mailing Address - Fax:305-665-2853
Practice Address - Street 1:7300 SW 57TH AVE
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5312
Practice Address - Country:US
Practice Address - Phone:305-665-2353
Practice Address - Fax:305-665-2853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO1747332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0989620001Medicare ID - Type UnspecifiedPROVIDER #