Organization
PELICAN PLAZA OPTICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN GRONDAHL D.O. (OPTICIAN/OWNER)
(941) 966-1559
Entity
Organization
Contact information
Practice address
8390 S TAMIAMI TRL, SARASOTA, FL 34238-2934
(941) 966-1559
(941) 966-1559
Mailing address
8390 S TAMIAMI TRL, SARASOTA, FL 34238-2934
(941) 966-1559
(941) 966-1559
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
3259
FL
335E00000X
Prosthetic/Orthotic Supplier
3259
FL
Other
Enumeration date
01/24/2008
Last updated
03/24/2008
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