| Organization Name: | OPTIMART, INC. |
| NPI Number: | 1013124882 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GREGORY LOUIS MATHIS (ADMINISTRATOR) |
| Mailing Address: | 2623 E Gulf To Lake Hwy Inverness |
| State: | FL US |
| Postal Code: | 344533216 |
| Phone Number: | 3526375180 |
| Fax Number: | 3526375181 |
| NPI Enumeration Date: | 05/17/2007 |
| NPI Last Update Date: | 05/14/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FX1800X |
| License Number: | OE386 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Optician |
| Taxonomy Definition: | |