Organization Name: | SAM'S OPTICAL WEST LLC |
NPI Number: | 1033514690 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SHELLY BERTIN (CO-OWNER) |
Mailing Address: | 3383 N Meridian Ave Newcastle |
State: | OK US |
Postal Code: | 730653634 |
Phone Number: | 4053874700 |
Fax Number: | |
NPI Enumeration Date: | 10/24/2014 |
NPI Last Update Date: | 10/24/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |