Provider Demographics
NPI:1457537284
Name:EYE Q INC
Entity Type:Organization
Organization Name:EYE Q INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN SOLE OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:WOLMETZ
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:561-968-1259
Mailing Address - Street 1:6486 LAKE WORTH RD
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-3008
Mailing Address - Country:US
Mailing Address - Phone:561-968-4942
Mailing Address - Fax:
Practice Address - Street 1:6486 LAKE WORTH RD
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-3008
Practice Address - Country:US
Practice Address - Phone:561-968-4942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO1058156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL086553200Medicaid
FL0954180001Medicare NSC