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General NPI Number Information
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NPI Number | 1316140205
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Entity Type | Organization
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Legal Business Name | OPTICAL ONE, INC.
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1750 SOUTH AVE
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City | YOUNGSTOWN
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State | OH
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Zip | 44502-2242
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Country | US
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Telephone | 330-743-8518
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Fax | 330-743-0966
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Provider Business Mailing Address
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Address Line | PO BOX 489
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City | YOUNGSTOWN
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State | OH
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Zip | 44501-0489
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Country | US
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Telephone | 330-743-8518
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Fax | 330-743-0966
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. EDWARD J DEBLASIO
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Credential |
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Telephone | 330-743-8518
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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 |
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License Number State |
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