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General NPI Number Information
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NPI Number | 1356744809
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Entity Type | Organization
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Legal Business Name | ADVANCED OPTICAL COMPANY, LLC
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Dates
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Enumeration Date | 09/29/2014
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Last Update Date | 02/02/2024
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Provider Practice Location Address
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Address Line | 1991 PARK AVE W
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City | ONTARIO
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State | OH
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Zip | 44906-2233
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Country | US
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Telephone | 419-521-3937
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Fax | 419-522-5189
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Provider Business Mailing Address
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Address Line | 1991 PARK AVE W
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City | ONTARIO
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State | OH
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Zip | 44906-2233
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Country | US
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Telephone | 419-521-3937
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Fax | 419-522-5189
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Authorized Official
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Title or Position | PRESIDENT
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Name | HAROLD A BALLITCH II
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Credential | M.D.
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Telephone | 419-521-3937
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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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