Provider Demographics
NPI:1437329778
Name:INVERRARY OPTICAL INC.
Entity type:Organization
Organization Name:INVERRARY OPTICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GOULD
Authorized Official - Suffix:SR
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:954-942-7717
Mailing Address - Street 1:2000 N FEDERAL HWY
Mailing Address - Street 2:STE 100
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-1022
Mailing Address - Country:US
Mailing Address - Phone:954-942-7717
Mailing Address - Fax:954-942-2248
Practice Address - Street 1:2000 N FEDERAL HWY
Practice Address - Street 2:STE 100
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-1022
Practice Address - Country:US
Practice Address - Phone:954-942-7717
Practice Address - Fax:954-942-2248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1489332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0709620001Medicare NSC