Provider Demographics
NPI:1801113725
Name:METRO MEDICAL PLAZA OPTICAL
Entity type:Organization
Organization Name:METRO MEDICAL PLAZA OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:GUILLERMO
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:239-334-2015
Mailing Address - Street 1:13691 METRO PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4327
Mailing Address - Country:US
Mailing Address - Phone:239-334-2015
Mailing Address - Fax:239-936-0047
Practice Address - Street 1:13691 METRO PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4327
Practice Address - Country:US
Practice Address - Phone:239-334-2015
Practice Address - Fax:239-936-0047
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLAMINGO ISLAND OPTICIANS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-02
Last Update Date:2010-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier