# OPTICLUB EXPRESS, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Opticlub Express
- **Organization subpart:** No

## Provider details

- **NPI number:** 1801381819
- **Authorized official:** DR. ANDREW DAVID BURTCHELL OD (PRESIDENT/DIRECTOR)
- **Authorized official phone:** (850) 910-4840

## Contact information

- **Practice address:** 4954 HIGHWAY 90, PACE, FL 32571-1413
- **Practice address phone:** (850) 910-4840
- **Practice address fax:** (850) 254-2970
- **Mailing address:** 4954 HIGHWAY 90, PACE, FL 32571-1413
- **Mailing address phone:** (850) 910-4840
- **Mailing address fax:** (850) 254-2970

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | — | NULL | Yes |
| 152W00000X | Optometrist | — | — | Yes |

## Other

- **Enumeration date:** 06/22/2018
- **Last updated:** 12/28/2019