National Provider Identifier Database

SPACECOASTPOP LLC
Optician


Contact Information

SPACECOASTPOP LLC
601 E STRAWBRIDGE AVE
MELBOURNE, FL32901-4733
Phone: 321-301-0411
Fax:
Website:
Specialty Taxonomy Code
* Optician 156FX1800X
Contact Lens Fitter 156FC0801X

* Indicates primary specialty

NPI Profile & details for SPACECOASTPOP LLC

NPI Number 1023807716
Legal business name
LBN
SPACECOASTPOP LLC
Authorized official ERICK ROSS - (PRESIDENT)
Entity Organization
Organization subpart Yes
Enumeration date 05/01/2025
Last updated 05/01/2025 - More than a year ago
Sole proprietor1 Not specified
Identifiers n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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