Provider Demographics
NPI:1831842079
Name:BEACH OPTICAL ONE HOUR EYEWEAR
Entity type:Organization
Organization Name:BEACH OPTICAL ONE HOUR EYEWEAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAOS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROKANAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-551-9201
Mailing Address - Street 1:3005 S FEDERAL HWY # 2
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-3219
Mailing Address - Country:US
Mailing Address - Phone:561-274-8629
Mailing Address - Fax:
Practice Address - Street 1:3005 S FEDERAL HWY # 2
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-3219
Practice Address - Country:US
Practice Address - Phone:561-274-8629
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty