Provider Demographics
NPI:1194073361
Name:OPTIEXPRESS INC
Entity type:Organization
Organization Name:OPTIEXPRESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:WITHERINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:239-541-2020
Mailing Address - Street 1:513 CAPE CORAL PKWY W
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-8507
Mailing Address - Country:US
Mailing Address - Phone:239-541-2020
Mailing Address - Fax:
Practice Address - Street 1:513 CAPE CORAL PKWY W
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-8507
Practice Address - Country:US
Practice Address - Phone:239-541-2020
Practice Address - Fax:239-541-9300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1595332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19010OtherMEDICARE