Provider Demographics
NPI:1841896248
Name:GARLOCK RV OPTICIANS
Entity type:Organization
Organization Name:GARLOCK RV OPTICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ LDO
Authorized Official - Prefix:
Authorized Official - First Name:FRANTZ
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARD
Authorized Official - Suffix:
Authorized Official - Credentials:DO6500
Authorized Official - Phone:954-565-4009
Mailing Address - Street 1:4800 NE 20TH TER STE 305
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4510
Mailing Address - Country:US
Mailing Address - Phone:954-565-4009
Mailing Address - Fax:954-333-2235
Practice Address - Street 1:4800 NE 20TH TER STE 305
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4510
Practice Address - Country:US
Practice Address - Phone:954-565-4009
Practice Address - Fax:954-333-2235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty