Healthcare Provider Details

I. General information

NPI: 1730197799
Provider Name (Legal Business Name): ACTON OPTICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 04/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3628 KIMBALL AVE
WATERLOO IA
50702-5731
US

IV. Provider business mailing address

3628 KIMBALL AVE
WATERLOO IA
50702-5731
US

V. Phone/Fax

Practice location:
  • Phone: 319-233-5246
  • Fax: 319-833-8197
Mailing address:
  • Phone: 319-233-5246
  • Fax: 319-833-8197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: MR. RANDY D BETSWORTH
Title or Position: OPTICIAN-CERTIFIED
Credential:
Phone: 319-233-5246