=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811131956
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | U.S. OPTICAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2009
-----------------------------------------------------
Last Update Date | 04/20/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2346 S CAMPBELL AVE
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65807-2972
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-883-5816
-----------------------------------------------------
Fax | 417-883-6924
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 325 N 72ND ST
-----------------------------------------------------
City | OMAHA
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68114-3605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-551-9541
-----------------------------------------------------
Fax | 402-551-9606
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. HARLAN RIPS
-----------------------------------------------------
Credential | DISPENSING OPTICIAN
-----------------------------------------------------
Telephone | 402-551-9541
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332900000X
-----------------------------------------------------
Taxonomy Name | Non-Pharmacy Dispensing Site
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------