Lice Avengers of SW Florida LLC

Primary specialty

Other TechnicianTaxonomy code 247200000X

Legal business name

LICE AVENGERS OF SW FLORIDA LLC

Doing business as

Lice Clinics of America of Southwest Florida

Practice address

8881 Terrene CT Ste 104
Bonita Springs, FL 34135-9528

Phone

(239) 237-0757

NPI assigned

Jan 31, 2018

Organization subpart

No

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

Authorized official

Name

Mr. Jeffrey Randolph

Title

Owner

Phone

(608) 509-6807

Specialties & licenses 1

Addresses

Other names 1

• Lice Clinics of America of Southwest Florida Doing business as

Locations

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

{
    "created_epoch": "1517356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1517356800000",
    "number": "1730687070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8881 TERRENE CT STE 104",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341359528",
            "telephone_number": "239-237-0757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8881 TERRENE CT STE 104",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341359528",
            "telephone_number": "239-237-0757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LICE AVENGERS OF SW FLORIDA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-31",
        "last_updated": "2018-01-31",
        "status": "A",
        "authorized_official_last_name": "RANDOLPH",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "608-509-6807",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "247200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician, Other",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lice Clinics of America of Southwest Florida",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Other Technician in Bonita Springs, FL
• Providers in Bonita Springs, FL by specialty
• Other Technician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2018; 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.