Provider Demographics
NPI:1720305170
Name:CONTACTS AND GLASSES
Entity Type:Organization
Organization Name:CONTACTS AND GLASSES
Other - Org Name:CONTACTS AND GLASSES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:MORREALE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:321-752-5454
Mailing Address - Street 1:PO BOX 121066
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32912-1066
Mailing Address - Country:US
Mailing Address - Phone:321-759-3510
Mailing Address - Fax:321-752-5405
Practice Address - Street 1:1124 S WICKHAM RD
Practice Address - Street 2:
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-2442
Practice Address - Country:US
Practice Address - Phone:321-752-5454
Practice Address - Fax:321-752-5405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-26
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP-3146152W00000X
152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620353100Medicaid
FL620350300Medicaid
FL620353100Medicaid
FLU63267Medicare UPIN
FLU69689Medicare UPIN
FL20820Medicare PIN