Organization
SPECS AND WINKS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK BLAKE (OWNER)
(561) 745-6464
Entity
Organization
Contact information
Practice address
175 TONEY PENNA DR, SUITE 102, JUPITER, FL 33458-5755
(561) 745-6464
(561) 745-4066
Mailing address
175 TONEY PENNA DR, SUITE 102, JUPITER, FL 33458-5755
(561) 745-6464
(561) 745-4066
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
DO5447
FL
Other
Enumeration date
03/20/2007
Last updated
08/22/2020
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