Provider Demographics
NPI:1942735089
Name:AMERICA OPTICAL AB GROUP CORP
Entity Type:Organization
Organization Name:AMERICA OPTICAL AB GROUP CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAYZA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DE SOUZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-482-0030
Mailing Address - Street 1:1377 S MILITARY TRL
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-7634
Mailing Address - Country:US
Mailing Address - Phone:954-482-0030
Mailing Address - Fax:954-531-6938
Practice Address - Street 1:1377 S MILITARY TRL
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-7634
Practice Address - Country:US
Practice Address - Phone:954-482-0030
Practice Address - Fax:954-531-6938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1359156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty