Provider Demographics
NPI:1124172291
Name:OSPREY OPTICAL, INC.
Entity type:Organization
Organization Name:OSPREY OPTICAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:941-366-6366
Mailing Address - Street 1:2121 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-3804
Mailing Address - Country:US
Mailing Address - Phone:941-366-6366
Mailing Address - Fax:941-556-3768
Practice Address - Street 1:2121 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3804
Practice Address - Country:US
Practice Address - Phone:941-366-6366
Practice Address - Fax:941-556-3768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO3873332H00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD2053Medicare UPIN
FL0779090001Medicare ID - Type Unspecified