Provider Demographics
NPI:1801073416
Name:CHARLOTTE OPTICAL INC
Entity type:Organization
Organization Name:CHARLOTTE OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MURIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-625-9077
Mailing Address - Street 1:18401 MURDOCK CIR
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-1026
Mailing Address - Country:US
Mailing Address - Phone:941-625-9077
Mailing Address - Fax:941-625-9077
Practice Address - Street 1:18401 MURDOCK CIR
Practice Address - Street 2:SUITE A
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1026
Practice Address - Country:US
Practice Address - Phone:941-625-9077
Practice Address - Fax:941-258-9078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-25
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2032193332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0685200001Medicare NSC