Provider Demographics
NPI:1992311492
Name:CONWAY OPTICAL COMPANY
Entity type:Organization
Organization Name:CONWAY OPTICAL COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:STOCKER
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:407-601-0120
Mailing Address - Street 1:PO BOX 592923
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32859-2923
Mailing Address - Country:US
Mailing Address - Phone:407-601-0120
Mailing Address - Fax:407-601-0434
Practice Address - Street 1:3834 CURRY FORD RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2708
Practice Address - Country:US
Practice Address - Phone:407-601-0120
Practice Address - Fax:407-601-0434
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONWAY OPTICAL COMPANY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-20
Last Update Date:2020-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty