NPIMap

Organization Active NPI

Prison Rehabilitative Industries Diversified Enterprises, Inc

  • Eyewear Supplier
  • Ft Lauderdale, FL
National Provider Identifier
1659531309
Registry record updated Jun 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
License
S. 2220 Issued in OH
Legal business name
PRISON REHABILITATIVE INDUSTRIES DIVERSIFIED ENTERPRISES, INC
Practice address
20421 Sheridan St
Ft Lauderdale, FL 33332-2300
Phone
(800) 523-1766
Fax
(813) 890-2103
NPI assigned
Jun 16, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2008

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

Authorized official

Name
Mr. Peter Radanovich
Title
Chief Financial Officer
Phone
(727) 556-3370

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X S. 2220 OH Primary

Addresses

Primary practice location

20421 Sheridan St
Ft Lauderdale, FL 33332-2300

Mailing address

12425 28TH St N
Suite 300
St Petersburg, FL 33716-1844
Phone (727) 572-1987

Other identifiers 1

IdentifierTypeStateIssuer
086571100MedicaidFL

Other names 1

  • P.R.I.D.E Broward Optical Other name

National Provider Directory

National Provider Directory
Tax ID family
Pride Broward Optical2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

12425 28th St N
Ste 300
St Petersburg, FL 33716
Phone (727) 556-3300

NPI Registry JSON

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

{
    "created_epoch": "1213574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213574400000",
    "number": "1659531309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12425 28TH ST N",
            "address_2": "SUITE 300",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337161844",
            "telephone_number": "727-572-1987",
            "fax_number": "727-570-3378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20421 SHERIDAN ST",
            "city": "FT LAUDERDALE",
            "state": "FL",
            "postal_code": "333322300",
            "telephone_number": "800-523-1766",
            "fax_number": "813-890-2103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRISON REHABILITATIVE INDUSTRIES DIVERSIFIED ENTERPRISES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-16",
        "last_updated": "2008-06-16",
        "status": "A",
        "authorized_official_last_name": "RADANOVICH",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "727-556-3370",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "OH",
            "license": "S. 2220",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "086571100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "P.R.I.D.E Broward Optical",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Ft Lauderdale, FL

Sources for this page

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