1407391469 NPI number — OPTICS UNLIMITED INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407391469 NPI number — OPTICS UNLIMITED INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPTICS UNLIMITED INC.
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:
OPTICS UNLIMITED
Provider Other Organization Name Type Code:
3
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:
1407391469
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1717 OAK PARK BLVD
Provider Second Line Business Mailing Address:
1
Provider Business Mailing Address City Name:
LAKE CHARLES
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70601-8991
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-478-3810
Provider Business Mailing Address Fax Number:
337-478-6360

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 1ST AVE
Provider Second Line Business Practice Location Address:
A
Provider Business Practice Location Address City Name:
LAKE CHARLES
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70601-8884
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-310-0767
Provider Business Practice Location Address Fax Number:
337-310-0786
Provider Enumeration Date:
12/30/2016

Additional Information

Authorized Official

Authorized Official Last Name:
ROBINSON
Authorized Official First Name:
ANGELA
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
ACCOUNTS RECEIVABLE SUPERVISOR
Authorized Official Telephone Number:
337-478-3810

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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