Provider Demographics
NPI:1952576175
Name:SHARED INC ABOUT EYES
Entity Type:Organization
Organization Name:SHARED INC ABOUT EYES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRES.
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:O
Authorized Official - Last Name:BUTTERFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-741-6802
Mailing Address - Street 1:7569 W OAKLAND PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-4909
Mailing Address - Country:US
Mailing Address - Phone:954-741-6802
Mailing Address - Fax:954-749-7817
Practice Address - Street 1:7569 W OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-4909
Practice Address - Country:US
Practice Address - Phone:954-741-6802
Practice Address - Fax:954-749-7817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO 2218332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1286070001Medicare NSC