Organization Name: | MR MIKES 39.95 OPTICAL L.L.C. |
NPI Number: | 1245622703 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | NOAH YUCHNITZ (CEO) |
Mailing Address: | 5755 Nw Loop 410 Suite 105 San Antonio |
State: | TX US |
Postal Code: | 782382502 |
Phone Number: | 2106563995 |
Fax Number: | 2102578466 |
NPI Enumeration Date: | 02/20/2015 |
NPI Last Update Date: | 02/20/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332B00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | |
Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |