Provider Demographics
NPI:1942478557
Name:M & C OPTICS LLC
Entity Type:Organization
Organization Name:M & C OPTICS LLC
Other - Org Name:GARDEN VISION OPTIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:COOPERSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-622-1388
Mailing Address - Street 1:4530 PGA BLVD
Mailing Address - Street 2:STE 105
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-3912
Mailing Address - Country:US
Mailing Address - Phone:561-622-1388
Mailing Address - Fax:561-622-2408
Practice Address - Street 1:4530 PGA BLVD
Practice Address - Street 2:STE 105
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418-3912
Practice Address - Country:US
Practice Address - Phone:561-622-1388
Practice Address - Fax:561-622-2408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-16
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO1568156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6093120001Medicare NSC