Healthcare Provider Details

I. General information

NPI: 1801953773
Provider Name (Legal Business Name): RX OPTICAL LABORATORIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 12/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4191 PLAINFIELD AVE NE
GRAND RAPIDS MI
49525-1604
US

IV. Provider business mailing address

1700 S PARK ST
KALAMAZOO MI
49001-2759
US

V. Phone/Fax

Practice location:
  • Phone: 616-364-8144
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: STEVEN W YONKE
Title or Position: CFO
Credential:
Phone: 269-342-0003