Provider Demographics
NPI:1053418186
Name:FLORIDA OPTICAL INC.
Entity type:Organization
Organization Name:FLORIDA OPTICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:FUSSELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:407-862-7699
Mailing Address - Street 1:1011 W VINE ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4166
Mailing Address - Country:US
Mailing Address - Phone:407-862-7699
Mailing Address - Fax:407-862-9672
Practice Address - Street 1:1011 W VINE ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4166
Practice Address - Country:US
Practice Address - Phone:407-862-7699
Practice Address - Fax:407-862-9672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1993152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9801Medicare ID - Type UnspecifiedGROUP NUMBER
FLT93969Medicare UPIN