Mastercraft Optical Gallery, Inc.

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

D02342 Issued in FL

Legal business name

MASTERCRAFT OPTICAL GALLERY, INC.

Practice address

520 S Parrott Ave
Okeechobee, FL 34974-4345

Phone

(863) 763-4334

Fax

(863) 763-3226

NPI assigned

Sep 21, 2006

Last updated

Sep 16, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Gwendolyn J King, LDONPI 1164481123

Title

Owner

Phone

(863) 763-4334

Specialties & licenses 1

Addresses

Other identifiers 2

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gwendolyn J King, OPTICIAN

  • Optician
  • Okeechobee, FL
  • NPI 1164481123
  Authorized official Same address or phone

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221523200000",
    "number": "1407954399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 S PARROTT AVE",
            "city": "OKEECHOBEE",
            "state": "FL",
            "postal_code": "349744345",
            "telephone_number": "863-763-4334",
            "fax_number": "863-763-3226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 S PARROTT AVE",
            "city": "OKEECHOBEE",
            "state": "FL",
            "postal_code": "349744345",
            "telephone_number": "863-763-4334",
            "fax_number": "863-763-3226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MASTERCRAFT OPTICAL GALLERY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2008-09-16",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "GWENDOLYN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "863-763-4334",
        "authorized_official_credential": "LDO"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "FL",
            "license": "D02342",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "086132400",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "D7841",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mark J Moll OD LLC
• Melissa L Markham, PA
• Markiv Consultants, LLC
• Gem Martin
• Yenisbel Martinez Perez, DMD
• Brooke N Mavroides, PA
• Regina Mayernik
• Darlene Mayers, LMFT
• Susanne Burkes McCoin, LCSW
• Thomas J McElligott, MD

• Eyewear Supplier in Okeechobee, FL
• Providers in Okeechobee, FL by specialty
• Eyewear Supplier in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2008; 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.