Organization Name: | OPTICAL CENTER |
NPI Number: | 1548585763 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SUSAN EDICK (MC ASSISTANT) |
Mailing Address: | 506 Larcher Blvd Bldg 2306 Keesler Afb |
State: | MS US |
Postal Code: | 395342342 |
Phone Number: | 2284354418 |
Fax Number: | 2284322324 |
NPI Enumeration Date: | 03/30/2010 |
NPI Last Update Date: | 03/30/2010 |
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: |