Provider Demographics
NPI:1134359383
Name:FAMILY EYEWEAR
Entity type:Organization
Organization Name:FAMILY EYEWEAR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/LISCENSED OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MARC
Authorized Official - Last Name:CAMPOREALE
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:561-479-4765
Mailing Address - Street 1:8177 GLADES RD
Mailing Address - Street 2:BAY#3
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-4071
Mailing Address - Country:US
Mailing Address - Phone:561-479-4765
Mailing Address - Fax:561-479-4628
Practice Address - Street 1:8177 GLADES RD
Practice Address - Street 2:BAY#3
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-4071
Practice Address - Country:US
Practice Address - Phone:561-479-4765
Practice Address - Fax:561-479-4628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5930156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty