Provider Demographics
NPI:1598564502
Name:COSMIC CONTACT LENSES AND GLASSES LLC
Entity type:Organization
Organization Name:COSMIC CONTACT LENSES AND GLASSES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER LICENSED OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MELENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO7722
Authorized Official - Phone:561-800-4066
Mailing Address - Street 1:2237 SW EDISON CIR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-2920
Mailing Address - Country:US
Mailing Address - Phone:561-800-4066
Mailing Address - Fax:
Practice Address - Street 1:6525 SOUTHERN BLVD STE 6
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33413-1720
Practice Address - Country:US
Practice Address - Phone:561-662-2282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens FitterGroup - Multi-Specialty