Healthcare Provider Details

I. General information

NPI: 1689057580
Provider Name (Legal Business Name): PLESSEN OPTICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2015
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 ORANGE GROVE
CHRISTIANSTED VI
00820
US

IV. Provider business mailing address

3004 ORANGE GROVE SUITE 2
CHRISTIANSTED VI
00820-4288
US

V. Phone/Fax

Practice location:
  • Phone: 340-715-7720
  • Fax: 340-713-9002
Mailing address:
  • Phone: 340-715-7720
  • Fax: 340-713-9002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. JAN BIJAN TAWAKOL
Title or Position: CEO
Credential: M.D.
Phone: 340-715-7720