Organization
CABANA EYES OPTICAL
Active
Parent organization
EDWARD MITCHELL JR
Organization subpart
Yes
Provider details
NPI number
Legal business name
EDWARD MITCHELL JR
Authorized official
MR. EDWARD MITCHELL JR. LDO (OWNER/ VISUAL RESOURCE DIRECTOR)
(850) 758-0474
Entity
Organization
Contact information
Practice address
4100 S FERDON BLVD, SUITE B5, CRESTVIEW, FL 32536-5252
(850) 758-0474
(850) 826-0057
Mailing address
4100 S FERDON BLVD, SUITE B5, CRESTVIEW, FL 32536-5252
(850) 306-2580
(850) 423-0142
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
—
—
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003088900
—
FL
Enumeration date
01/10/2017
Last updated
10/23/2019
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