Organization
PHYSICIANS OPTICAL LAB INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM J BROUSSARD MD (PRESIDENT)
(321) 727-2020
Entity
Organization
Contact information
Practice address
502 E NEW HAVE AVE, MELBOURNE, FL 32901-5427
(321) 722-3715
(321) 722-3187
Mailing address
502 E NEW HAVE AVE, MELBOURNE, FL 32901-5427
(321) 722-3715
(321) 722-3187
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Enumeration date
10/02/2006
Last updated
08/22/2020
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