Provider Demographics
NPI:1346087509
Name:INFINITY VISION OPTICAL BOUTIQUE
Entity type:Organization
Organization Name:INFINITY VISION OPTICAL BOUTIQUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIEGO
Authorized Official - Middle Name:LUCIANO
Authorized Official - Last Name:PIRES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:908-696-3463
Mailing Address - Street 1:5135 INTERNATIONAL DR STE 15
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-9451
Mailing Address - Country:US
Mailing Address - Phone:908-696-3463
Mailing Address - Fax:
Practice Address - Street 1:5135 INTERNATIONAL DR STE 15
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-9451
Practice Address - Country:US
Practice Address - Phone:407-745-4066
Practice Address - Fax:407-745-4067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-13
Last Update Date:2024-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty