Organization
MASTERCRAFT OPTICAL GALLERY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GWENDOLYN J KING LDO (OWNER)
(863) 763-4334
Entity
Organization
Contact information
Practice address
520 S PARROTT AVE, OKEECHOBEE, FL 34974-4345
(863) 763-4334
(863) 763-3226
Mailing address
520 S PARROTT AVE, OKEECHOBEE, FL 34974-4345
(863) 763-4334
(863) 763-3226
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
D02342
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
086132400
—
FL
01
—
D7841
BLUE CROSS BLUE SHIELD
FL
Enumeration date
09/21/2006
Last updated
09/16/2008
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