Provider Demographics
NPI:1447650312
Name:RIVERVIEW OPTICAL INC.
Entity type:Organization
Organization Name:RIVERVIEW OPTICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, LICENSE OPTICAN
Authorized Official - Prefix:
Authorized Official - First Name:KARL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARVEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO3877
Authorized Official - Phone:813-677-0229
Mailing Address - Street 1:7037 US HIGHWAY 301 S
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-4344
Mailing Address - Country:US
Mailing Address - Phone:813-677-0229
Mailing Address - Fax:813-677-0137
Practice Address - Street 1:7037 US HIGHWAY 301 S
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-4344
Practice Address - Country:US
Practice Address - Phone:813-677-0229
Practice Address - Fax:813-677-0137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO3877332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1275671489Medicare NSC