Provider Demographics
NPI:1124142906
Name:SEACREST OPTICAL INCORPORATED
Entity type:Organization
Organization Name:SEACREST OPTICAL INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OPTICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHAINKIN
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:561-496-2020
Mailing Address - Street 1:7263 W ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-1305
Mailing Address - Country:US
Mailing Address - Phone:561-496-2020
Mailing Address - Fax:
Practice Address - Street 1:7263 W ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-1305
Practice Address - Country:US
Practice Address - Phone:561-496-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1531305R00000X, 302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111800OtherEYEMED ID NUMBER
FL139145OtherEYE MED VISION CARE
FL111800OtherEYEMED ID NUMBER