Organization
PALM COAST EYEWEAR, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA RENEE NICHOLS (PRACTICE MANAGER)
(941) 794-2020
Entity
Organization
Contact information
Practice address
3131 S TAMIAMI TRL, SUITE 101, SARASOTA, FL 34239-5101
(941) 954-1001
(941) 951-6957
Mailing address
3131 S TAMIAMI TRL, SUITE 101, SARASOTA, FL 34239-5101
(941) 954-1001
(941) 951-6957
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
DO954
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DO1106
OPTICIAN LICENSE
FL
Enumeration date
05/22/2006
Last updated
04/20/2008
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