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General NPI Number Information
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NPI Number | 1134503352
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Entity Type | Organization
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Legal Business Name | THE OPTICAL CENTER, INC
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Dates
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Enumeration Date | 07/17/2015
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Last Update Date | 07/17/2015
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Provider Practice Location Address
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Address Line | 1316 NORTH AVE
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-6419
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Country | US
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Telephone | 970-245-6821
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Fax | 970-243-4046
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Provider Business Mailing Address
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Address Line | 1316 NORTH AVE
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-6419
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Country | US
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Telephone | 970-245-6821
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Fax | 970-243-4046
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. PHILLIP K BAGGA
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Credential | OPTICIAN
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Telephone | 970-245-6821
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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 | 042267650000
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License Number State | CO
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