=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124116488
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OPTICS LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1330 EXCHANGE ST SUITE 101
-----------------------------------------------------
City | MIDDLEBURY
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05753-4425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-388-4456
-----------------------------------------------------
Fax | 803-388-9639
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1330 EXCHANGE ST SUITE 101
-----------------------------------------------------
City | MIDDLEBURY
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05753-4425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-388-4456
-----------------------------------------------------
Fax | 803-388-9639
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | G.MANAGER/OWNER
-----------------------------------------------------
Name | MR. MAHMOUD A. HAYYAT
-----------------------------------------------------
Credential | OPTICIAN
-----------------------------------------------------
Telephone | 802-388-4456
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number | 028-0000176
-----------------------------------------------------
License Number State | VT
-----------------------------------------------------