Organization
OPTIMART, INC.
Active
Other names
OPTIMART, INC. #12
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY LOUIS MATHIS (ADMINISTRATOR)
(727) 914-8615
Entity
Organization
Contact information
Practice address
2637 E GULF TO LAKE HWY, INVERNESS, FL 34453-3216
(352) 637-5180
(352) 637-5181
Mailing address
4359 35TH ST N, SAINT PETERSBURG, FL 33714-3717
(727) 914-8615
(727) 914-8610
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
OE386
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
630126600
—
FL
Enumeration date
05/17/2007
Last updated
07/01/2020
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