Organization
OPTICAL BOUTIQUE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JUAN CARLOS FARIAS (OWNER)
(305) 324-0490
Entity
Organization
Contact information
Practice address
901 NW 17TH ST, SUITE P, MIAMI, FL 33136-1135
(305) 324-0490
(305) 324-9890
Mailing address
901 NW 17TH ST, SUITE P, MIAMI, FL 33136-1135
(305) 324-0490
(305) 324-9890
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
DO2329
FL
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
078328500
—
FL
Enumeration date
07/17/2007
Last updated
07/18/2019
Update your record
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