OrganizationActive
1162 Military Trail LLC
NPI 1750638755 · Optician · Santa Rosa Beach, FL
Provider details
- NPI number
- 1750638755
- Entity type
- Organization
- Primary specialty
- OpticianEye and Vision Services Providers
- Authorized official
- Galen Grayson, Owner/Medical Director
Practice location
25 Central Square
Santa Rosa Beach, FL 32459
Phone: (888) 264-4989
Fax: (850) 534-3022
Mailing address
25 Central Square
Santa Rosa Beach, FL 32459
Registry dates
- Enumerated
- 2012-08-08
- Last updated
- 2012-08-08
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.