Organization Name: | LICATA OPTICAL LLC |
NPI Number: | 1851675003 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JAMES J LICATA (MANAGER/OPTICIAN) |
Mailing Address: | 2048 E Baseline Rd C-6 Mesa |
State: | AZ US |
Postal Code: | 852046969 |
Phone Number: | 4806325075 |
Fax Number: | 4805070836 |
NPI Enumeration Date: | 10/06/2011 |
NPI Last Update Date: | 10/06/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332H00000X |
License Number: | 1185E |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Eyewear Supplier (Equipment, not the service) |
Taxonomy Specialization: | |
Taxonomy Definition: | An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist. |