Organization
PALM COAST EYEWEAR, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA RENEE NICHOLS (PRACTICE MANAGER)
(941) 794-2020
Entity
Organization
Contact information
Practice address
5601 21ST AVE W, SUITE C, BRADENTON, FL 34209-5642
(941) 794-1001
(941) 794-3280
Mailing address
5601 21ST AVE W, SUITE C, BRADENTON, FL 34209-5642
(941) 794-1001
(941) 794-3280
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
DO1765
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DO1765
OPTICIAN LICENSE
FL
Enumeration date
04/16/2007
Last updated
05/08/2008
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