Provider Demographics
NPI:1932503695
Name:OPTICAL CITY
Entity Type:Organization
Organization Name:OPTICAL CITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLIVE
Authorized Official - Middle Name:
Authorized Official - Last Name:LATTIBEAUDIERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-749-5881
Mailing Address - Street 1:10057B SUNSET STRIP
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33322-5301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10057B SUNSET STRIP
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33322-5301
Practice Address - Country:US
Practice Address - Phone:954-749-5881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOE2143332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier