Provider Demographics
NPI:1396805552
Name:FASHION OPTICAL CENTER
Entity type:Organization
Organization Name:FASHION OPTICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:BALGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-739-4868
Mailing Address - Street 1:3682 W OAKLAND PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33311
Mailing Address - Country:US
Mailing Address - Phone:954-739-4868
Mailing Address - Fax:954-730-7201
Practice Address - Street 1:3682 W OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33311
Practice Address - Country:US
Practice Address - Phone:954-739-4868
Practice Address - Fax:954-730-7201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0639110001Medicare ID - Type Unspecified