1225159213 NPI number — TWELVE THIRTY OPTICAL, INC.

Table of content: (NPI 1225159213)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225159213 NPI number — TWELVE THIRTY OPTICAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TWELVE THIRTY OPTICAL, 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:
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:
1225159213
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1117 MAGIE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRFIELD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45014-1823
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-829-8808
Provider Business Mailing Address Fax Number:
513-829-5305

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1117 MAGIE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45014-1823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-829-8808
Provider Business Practice Location Address Fax Number:
513-829-5305
Provider Enumeration Date:
04/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
IRVIN
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OWNER CONTACT LENS TECHNICIAN
Authorized Official Telephone Number:
513-829-8808

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X , with the licence number:  SC1577 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 23706 . This is a "SPECTERA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 30569 . This is a "DAVIS VISION" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: OH1577 . This is a "EYE MED" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 141502 . This is a "COLE MANAGED VISION" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com