| Organization Name: | OPTIMART, INC. |
| NPI Number: | 1124235049 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GREGORY LOUIS MATHIS (ADMINISTRATOR) |
| Mailing Address: | 10041a Us Highway 19 Port Richey |
| State: | FL US |
| Postal Code: | 346683742 |
| Phone Number: | 7278680780 |
| Fax Number: | 7278680819 |
| NPI Enumeration Date: | 05/17/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FX1800X |
| License Number: | OE391 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Optician |
| Taxonomy Definition: | |