Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Optician |
156FX1800X | 96[5] | Optician | |
Contact Lens Fitter |
156FC0801X |
| NPI # | 1023807716 |
| LBN Legal business name | SPACECOASTPOP LLC |
| Authorized official | ERICK ROSS - (PRESIDENT) |
| Entity | Organization |
| Organization subpart 1 | Yes |
| Enumeration date | 05/01/2025 |
| Last updated | 05/01/2025 - More than a year ago |
| Identifiers | n/a |
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