| Organization Name: | OPTICAL BY THE SEA, INC. |
| NPI Number: | 1851658264 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | STEVEN EDONAIS JORDAN (OWNER / OPTICIAN) |
| Mailing Address: | 235 East Commercial Blvd. Suite # 103 Lauderdale By The Sea |
| State: | FL US |
| Postal Code: | 333084430 |
| Phone Number: | 9544915818 |
| Fax Number: | 9544915819 |
| NPI Enumeration Date: | 04/23/2012 |
| NPI Last Update Date: | 04/23/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FX1800X |
| License Number: | DO-3073 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Optician |
| Taxonomy Definition: | |