Organization
PRISON REHABILITATIVE INDUSTRIES DIVERSIFIED ENTERPRISES, INC
Active
Other names
P.R.I.D.E Broward Optical
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PETER RADANOVICH (CHIEF FINANCIAL OFFICER)
(727) 556-3370
Entity
Organization
Contact information
Practice address
20421 SHERIDAN ST, FT LAUDERDALE, FL 33332-2300
(800) 523-1766
(813) 890-2103
Mailing address
12425 28TH ST N, SUITE 300, ST PETERSBURG, FL 33716-1844
(727) 572-1987
(727) 570-3378
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
S. 2220
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
086571100
—
FL
Enumeration date
06/16/2008
Last updated
06/16/2008
Update your record
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