1134506983 NPI number — ONE WORLD OPTICAL BUSINESS L.L.C.

Table of content: (NPI 1134506983)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134506983 NPI number — ONE WORLD OPTICAL BUSINESS L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ONE WORLD OPTICAL BUSINESS L.L.C.
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:
1134506983
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1076 GABLES DR
Provider Second Line Business Mailing Address:
APT 207
Provider Business Mailing Address City Name:
FOREST
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24551-4755
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-382-8207
Provider Business Mailing Address Fax Number:
434-266-0078

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105A TRADEWYND DR
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
LYNCHBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24502-3112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-382-8207
Provider Business Practice Location Address Fax Number:
434-266-0078
Provider Enumeration Date:
04/30/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SHAHMIRZADI
Authorized Official First Name:
MARTIN
Authorized Official Middle Name:
Authorized Official Title or Position:
ABOC/LICENSED OPTICIAN/OWNER
Authorized Official Telephone Number:
434-382-8207

Provider Taxonomy Codes

  • Taxonomy code: 156FX1800X , with the licence number:  1101003537 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332H00000X , with the licence number: 1101003537 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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