Organization
EXCLUSIVE EYEWEAR NO. 2, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE BENNETT (CREDENTIALING SUPERVISOR)
(561) 612-4531
Entity
Organization
Contact information
Practice address
1150 N FEDERAL HWY STE 11561158, POMPANO BEACH, FL 33062-4322
(954) 582-2100
(561) 828-8367
Mailing address
1156 - 1158 FEDERAL HIGHWAY, POMPANO BEACH, FL 33062
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Enumeration date
08/12/2020
Last updated
02/19/2021
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