Provider Demographics
NPI:1902918535
Name:BEACH OPTICAL COMPANY
Entity Type:Organization
Organization Name:BEACH OPTICAL COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:MATHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:904-221-6319
Mailing Address - Street 1:21 12TH ST S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-3433
Mailing Address - Country:US
Mailing Address - Phone:904-249-2166
Mailing Address - Fax:904-246-2383
Practice Address - Street 1:21 12TH ST S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3433
Practice Address - Country:US
Practice Address - Phone:904-249-2166
Practice Address - Fax:904-246-2383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL552332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0694370002Medicare NSC