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General NPI Number Information
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NPI Number | 1659784965
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Entity Type | Organization
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Legal Business Name | OPTICALSOLUTIONS
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Dates
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Enumeration Date | 06/04/2014
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Last Update Date | 06/04/2014
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Provider Practice Location Address
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Address Line | 6006 MAHONING AVE
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City | AUSTINTOWN
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State | OH
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Zip | 44515-2239
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Country | US
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Telephone | 330-797-8780
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Fax | 330-797-8781
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Provider Business Mailing Address
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Address Line | 6006 MAHONING AVE
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City | AUSTINTOWN
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State | OH
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Zip | 44515-2239
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Country | US
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Telephone | 330-797-8780
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Fax | 330-797-8781
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SUE MORAN
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Credential |
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Telephone | 330-565-4195
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4027 T1760
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3166 T46977
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License Number State | OH
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