Healthcare Provider Details

I. General information

NPI: 1497273403
Provider Name (Legal Business Name): RX OPTICAL LABORATORIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2017
Last Update Date: 12/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3445 HENRY ST
NORTON SHORES MI
49441
US

IV. Provider business mailing address

1825 SOUTH PARK ST
KALAMAZOO MI
49001-2779
US

V. Phone/Fax

Practice location:
  • Phone: 231-220-0223
  • Fax:
Mailing address:
  • Phone: 269-342-0003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: STEPHAN JEPSON
Title or Position: PRESIDENT
Credential:
Phone: 269-342-0003