Provider Demographics
NPI:1881791044
Name:CAPPUCCIO ENTERPRISE
Entity type:Organization
Organization Name:CAPPUCCIO ENTERPRISE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:CAPPUCCIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-563-5331
Mailing Address - Street 1:2140 E OAKLAND PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1109
Mailing Address - Country:US
Mailing Address - Phone:954-563-5331
Mailing Address - Fax:954-563-5331
Practice Address - Street 1:2140 E OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1109
Practice Address - Country:US
Practice Address - Phone:954-563-5331
Practice Address - Fax:954-563-5331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0785660001Medicare ID - Type Unspecified