1162 Military Trail LLC
Technician/Technologist, Optician in Santa Rosa Beach, FL. Organization (NPI-2).
NPI number1750638755
StatusActive
Last updated in NPPESAug 8, 2012
Details
- NPI
- 1750638755
- Entity type
- Organization (NPI-2)
- Legal business name
- 1162 Military Trail LLC
- Organization subpart
- No
- Enumeration date
- Aug 8, 2012
- Last updated
- Aug 8, 2012
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 156FX1800X | Technician/Technologist, Optician | – | – | Yes |
Other names
- The Artful Eye-Seaside (Doing Business As)
Practice location
25 Central SquareSanta Rosa Beach, FL 32459
Phone 888-264-4989 · Fax 850-534-3022
Mailing address
25 Central SquareSanta Rosa Beach, FL 32459
Phone 888-264-4989 · Fax 850-534-3022
Authorized official
Galen Grayson
Owner/Medical Director
7042950001
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