Organization
FAMOUSPEOPLESEYEWEARANDKIDZBIZINC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANNETTE BARBARA RUSSELL DO (OWNNER)
(813) 737-1122
Entity
Organization
Contact information
Practice address
10423 CR39, LITHIA, FL 33547-2864
(813) 737-1122
(813) 737-1102
Mailing address
PO BOX 240, LITHIA, FL 33547-0240
(813) 737-1122
(813) 737-1102
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
DO2694
FL
Other
Enumeration date
02/15/2007
Last updated
08/22/2020
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