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General NPI Number Information
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NPI Number | 1780165084
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Entity Type | Organization
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Legal Business Name | B AND B OPTICAL MANAGEMENT, LLC
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Dates
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Enumeration Date | 08/24/2018
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Last Update Date | 03/08/2021
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Provider Practice Location Address
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Address Line | 16100 SAM RAYBURN TOLLWAY BUILDING A #130
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City | FRISCO
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State | TX
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Zip | 75035
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Country | US
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Telephone | 469-217-7300
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Fax | 561-828-8367
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Provider Business Mailing Address
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Address Line | 7579 OLIVIA CT
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City | WAYNESVILLE
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State | OH
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Zip | 45068-7205
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Country | US
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Telephone | 561-275-2020
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | JACKIE BENNETT
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Credential |
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Telephone | 561-433-6009
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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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