Provider Demographics
NPI:1023178852
Name:A & M BEACH OPTICAL
Entity type:Organization
Organization Name:A & M BEACH OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-343-1521
Mailing Address - Street 1:1155 PASADENA AVE S
Mailing Address - Street 2:SUITE B
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:FL
Mailing Address - Zip Code:33707-2878
Mailing Address - Country:US
Mailing Address - Phone:727-343-1521
Mailing Address - Fax:727-343-2490
Practice Address - Street 1:1155 PASADENA AVE S
Practice Address - Street 2:SUITE B
Practice Address - City:SOUTH PASADENA
Practice Address - State:FL
Practice Address - Zip Code:33707-2878
Practice Address - Country:US
Practice Address - Phone:727-343-1521
Practice Address - Fax:727-343-2490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2489156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0644240001Medicare ID - Type Unspecified