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General NPI Number Information
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NPI Number | 1821250218
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Entity Type | Organization
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Legal Business Name | RICK STANTON ENTERPRISES INCORPORATED DBA LAUREN TAYLOR EYEWEAR
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Dates
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Enumeration Date | 06/27/2008
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Last Update Date | 06/27/2008
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Provider Practice Location Address
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Address Line | 1945 LAKESHORE DR
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City | MUSKEGON
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State | MI
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Zip | 49441
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Country | US
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Telephone | 231-755-4060
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Fax |
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Provider Business Mailing Address
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Address Line | 1945 LAKESHORE DRIVE
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City | MUSKEGON
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State | MI
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Zip | 49441
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Country | US
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Telephone | 231-755-4060
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Fax | 231-755-9139
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Authorized Official
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Title or Position | OWNER OPTICIAN
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Name | MRS. JUDITH ANN OSBORNE
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Credential |
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Telephone | 231-755-4060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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