Provider Demographics
NPI:1699389320
Name:HERRERA OPTICS
Entity type:Organization
Organization Name:HERRERA OPTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-303-1173
Mailing Address - Street 1:5869 ATLANTIC AVE STE A2B
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-8402
Mailing Address - Country:US
Mailing Address - Phone:561-303-1173
Mailing Address - Fax:561-359-2172
Practice Address - Street 1:5869 ATLANTIC AVE STE A2B
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-8402
Practice Address - Country:US
Practice Address - Phone:561-303-1173
Practice Address - Fax:561-359-2172
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HERRERA OPTICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier