Provider Demographics
NPI:1740273879
Name:SEA-VIEW OPTICAL INC
Entity type:Organization
Organization Name:SEA-VIEW OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:BERGIDA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:561-276-5099
Mailing Address - Street 1:1715 S FEDERAL HWY
Mailing Address - Street 2:SUITE C-1
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-3329
Mailing Address - Country:US
Mailing Address - Phone:561-276-5099
Mailing Address - Fax:561-274-9697
Practice Address - Street 1:1715 S FEDERAL HWY
Practice Address - Street 2:SUITE C-1
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-3329
Practice Address - Country:US
Practice Address - Phone:561-276-5099
Practice Address - Fax:561-274-9697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1387332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL630337400Medicaid
FL630337400Medicaid