Provider Demographics
NPI:1427255751
Name:CAPPUCCIO ENTERPRISE
Entity type:Organization
Organization Name:CAPPUCCIO ENTERPRISE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:CAPPUCCIO
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:954-563-5331
Mailing Address - Street 1:2140 EAST OAKLAND PARK BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:FT.LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306
Mailing Address - Country:US
Mailing Address - Phone:954-563-5331
Mailing Address - Fax:954-563-9979
Practice Address - Street 1:2140 EAST OAKLAND PARK BOULEVARD
Practice Address - Street 2:
Practice Address - City:FT.LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306
Practice Address - Country:US
Practice Address - Phone:954-563-5331
Practice Address - Fax:954-563-9979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0785660001Medicare ID - Type Unspecified