Provider Demographics
NPI:1386788602
Name:OPTICAL EYEWORKS INC
Entity type:Organization
Organization Name:OPTICAL EYEWORKS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-757-2468
Mailing Address - Street 1:8124 WILES RD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-2061
Mailing Address - Country:US
Mailing Address - Phone:954-757-2468
Mailing Address - Fax:954-757-2456
Practice Address - Street 1:8124 WILES RD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-2061
Practice Address - Country:US
Practice Address - Phone:954-757-2468
Practice Address - Fax:954-757-2456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL1906156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL630203300Medicaid
FL630203300Medicaid