Healthcare Provider Details

I. General information

NPI: 1609922616
Provider Name (Legal Business Name): OPTICAL EYEWEAR INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 11/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 16TH ST STE 103
BAKERSFIELD CA
93301-3453
US

IV. Provider business mailing address

2323 16TH ST STE 103
BAKERSFIELD CA
93301-3453
US

V. Phone/Fax

Practice location:
  • Phone: 661-324-8836
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberD3385
License Number StateCA

VIII. Authorized Official

Name: FRANK URANDAY
Title or Position: PRESIDENT
Credential:
Phone: 661-324-8836