| Organization Name: | ELLIOTT OPTICAL INC. |
| NPI Number: | 1508039256 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PAUL ELLIOTT (PRESIDENT) |
| Mailing Address: | 561 Dal Hall Blvd Lake Placid |
| State: | FL US |
| Postal Code: | 338525446 |
| Phone Number: | 8634651777 |
| Fax Number: | 8634655279 |
| NPI Enumeration Date: | 04/02/2008 |
| NPI Last Update Date: | 05/21/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FX1800X |
| License Number: | DO676 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Optician |
| Taxonomy Definition: | |