| Organization Name: | THE OPTICAL SHOP INC. |
| NPI Number: | 1063588374 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TOM ANDERSON (OWNER) |
| Mailing Address: | 112 22nd Ave S Brookings |
| State: | SD US |
| Postal Code: | 570062600 |
| Phone Number: | 6056925173 |
| Fax Number: | 6056926710 |
| NPI Enumeration Date: | 11/28/2006 |
| NPI Last Update Date: | 04/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FX1800X |
| License Number: | 05001=========EST001 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SD |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Optician |
| Taxonomy Definition: | |