1831434174 NPI number — OPTICS PLUS LLC

Table of content: (NPI 1831434174)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831434174 NPI number — OPTICS PLUS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPTICS PLUS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831434174
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1343 WHITEHALL ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUSKEGON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-744-0440
Provider Business Mailing Address Fax Number:
231-719-0291

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1343 WHITEHALL ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUSKEGON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-744-0440
Provider Business Practice Location Address Fax Number:
231-719-0291
Provider Enumeration Date:
11/27/2012

Additional Information

Authorized Official

Authorized Official Last Name:
PRINCE
Authorized Official First Name:
DAWN
Authorized Official Middle Name:
JUNE
Authorized Official Title or Position:
OWNER/OPTICIAN
Authorized Official Telephone Number:
231-744-0440

Provider Taxonomy Codes

  • Taxonomy code: 152WX0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 864556948 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 944556039 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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