Provider Demographics
NPI:1780757898
Name:PLUMB OPTICAL, INC. D.B.A. YOUR EYES ONLY
Entity type:Organization
Organization Name:PLUMB OPTICAL, INC. D.B.A. YOUR EYES ONLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:PLUMB
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:561-795-8833
Mailing Address - Street 1:10111 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-4336
Mailing Address - Country:US
Mailing Address - Phone:561-795-8833
Mailing Address - Fax:561-795-7408
Practice Address - Street 1:10111 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-4336
Practice Address - Country:US
Practice Address - Phone:561-795-8833
Practice Address - Fax:561-795-7408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC003267152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU58001Medicare UPIN
FL6082660001Medicare NSC
FL20858Medicare ID - Type Unspecified