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Organization
BEACH VISION HOLDINGS, PA
Active
Organization
BEACH VISION HOLDINGS, PA
Active
Other names
Charles D Register OD, PA, Beach Vision Center
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN SIMPSON SULLENBERGER (AUTHORIZED OFFICIAL)
(386) 547-1549
Entity
Organization
Contact information
Practice address
103 FAULKNER ST, NEW SMYRNA BEACH, FL 32168-7017
(396) 423-7788
(386) 423-0035
Mailing address
103 FAULKNER ST, NEW SMYRNA BEACH, FL 32168-7017
(396) 423-7788
(386) 423-0035
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC 1689
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
078276900
—
FL
Enumeration date
03/29/2012
Last updated
08/20/2024
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