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General NPI Number Information
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NPI Number | 1083724892
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Entity Type | Organization
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Legal Business Name | GRANDE OPTICAL, INC.
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2115 BOCA CHICA BLVD SUITE B
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City | BROWNSVILLE
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State | TX
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Zip | 78521-2227
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Country | US
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Telephone | 956-550-9600
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Fax | 956-550-9697
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Provider Business Mailing Address
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Address Line | 2115 BOCA CHICA BLVD SUITE B
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City | BROWNSVILLE
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State | TX
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Zip | 78521-2227
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Country | US
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Telephone | 956-550-9600
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Fax | 956-550-9697
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. VIRGIL ALLEN CRITTENDEN
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Credential | OPTICIAN
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Telephone | 956-550-9600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | DR 3967
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License Number State | TX
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