Organization
OPTIMART, INC.
Active
Other names
OPTIMART, INC. #02
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY LOUIS MATHIS (ADMINISTRATOR)
(727) 914-8615
Entity
Organization
Contact information
Practice address
35170 US HIGHWAY 19 N, PALM HARBOR, FL 34684-1929
(727) 789-5333
(727) 223-9027
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
OE392
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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