# BEACH VISION HOLDINGS, PA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Charles D Register OD, PA, Beach Vision Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1346516747
- **Authorized official:** SUSAN SIMPSON SULLENBERGER (AUTHORIZED OFFICIAL)
- **Authorized official phone:** (386) 547-1549

## Contact information

- **Practice address:** 103 FAULKNER ST, NEW SMYRNA BEACH, FL 32168-7017
- **Practice address phone:** (396) 423-7788
- **Practice address fax:** (386) 423-0035
- **Mailing address:** 103 FAULKNER ST, NEW SMYRNA BEACH, FL 32168-7017
- **Mailing address phone:** (396) 423-7788
- **Mailing address fax:** (386) 423-0035

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | OPC 1689 | FL | Yes |

## Other

- **Enumeration date:** 03/29/2012
- **Last updated:** 08/20/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 078276900 | — | FL |