Provider Demographics
NPI:1487962437
Name:ABB/CON-CISE OPTICAL GROUP LLC
Entity type:Organization
Organization Name:ABB/CON-CISE OPTICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:954-733-2300
Mailing Address - Street 1:12301 NW 39TH ST
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-2403
Mailing Address - Country:US
Mailing Address - Phone:954-733-2300
Mailing Address - Fax:954-735-4386
Practice Address - Street 1:12301 NW 39TH ST
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-2403
Practice Address - Country:US
Practice Address - Phone:954-733-2300
Practice Address - Fax:954-735-4386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL332H00000XMedicare PIN