Provider Demographics
NPI:1265552889
Name:ADONIS OPTICAL, INC.
Entity type:Organization
Organization Name:ADONIS OPTICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WIEBOLD
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:352-367-0077
Mailing Address - Street 1:706 NW 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-8524
Mailing Address - Country:US
Mailing Address - Phone:352-367-0077
Mailing Address - Fax:352-367-0079
Practice Address - Street 1:706 NW 23RD AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-8524
Practice Address - Country:US
Practice Address - Phone:352-367-0077
Practice Address - Fax:352-367-0079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOE 1592156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOE 1592OtherOPTICAL ESTABLISHMENT PMT