Provider Demographics
NPI:1700073699
Name:NAPLES EYE PHYSICIANS OPTICAL SHOP, INC
Entity Type:Organization
Organization Name:NAPLES EYE PHYSICIANS OPTICAL SHOP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROUGRAFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-262-6288
Mailing Address - Street 1:661 GOODLETTE RD N
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5609
Mailing Address - Country:US
Mailing Address - Phone:239-435-0645
Mailing Address - Fax:239-262-5434
Practice Address - Street 1:661 GOODLETTE RD N
Practice Address - Street 2:SUITE 105
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5609
Practice Address - Country:US
Practice Address - Phone:239-435-0645
Practice Address - Fax:239-262-5434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1289470001Medicare NSC