Optical Outlet Inc IV

Primary specialty

OpticianTaxonomy code 156FX1800X

License

DO3422 Issued in FL

Legal business name

OPTICAL OUTLET INC IV

Practice address

319 SE Port St Lucie Blvd
Port St Lucie, FL 34984

Phone

(772) 878-1414

Fax

(772) 878-0118

NPI assigned

Apr 30, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lorraine O Arteaga

Title

Licensed Optician Owner

Phone

(772) 878-1414

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104046267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "319 SE PORT ST LUCIE BLVD",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "34984",
            "telephone_number": "772-878-1414",
            "fax_number": "772-878-0118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "319 SE PORT ST LUCIE BLVD",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "34984",
            "telephone_number": "772-878-1414",
            "fax_number": "772-878-0118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTICAL OUTLET INC IV",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ARTEAGA",
        "authorized_official_first_name": "LORRAINE",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "LICENSED OPTICIAN OWNER",
        "authorized_official_telephone_number": "772-878-1414"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": "FL",
            "license": "DO3422",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Optician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.