Organization Name: | HOMETOWN OPTICAL INC. |
NPI Number: | 1164668802 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | NATHAN SHANE STYRON (PRESIDENT/OPTICIAN) |
Mailing Address: | 13244 Us Highway 1 Sebastian |
State: | FL US |
Postal Code: | 329583750 |
Phone Number: | 7723880308 |
Fax Number: | 7722289111 |
NPI Enumeration Date: | 12/31/2008 |
NPI Last Update Date: | 12/31/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | DO4689 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |