Organization Name: | EDMOND OPTICAL SHOP, INC. |
NPI Number: | 1003022773 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LONNIE B. MASTERS (OWNEROPTICIAN) |
Mailing Address: | 920 S Bryant Ave Suite 101 Edmond |
State: | OK US |
Postal Code: | 730345797 |
Phone Number: | 4053416588 |
Fax Number: | 4053489537 |
NPI Enumeration Date: | 05/16/2007 |
NPI Last Update Date: | 05/20/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332H00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Eyewear Supplier (Equipment, not the service) |
Taxonomy Specialization: | |
Taxonomy Definition: | An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist. |