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General NPI Number Information
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NPI Number | 1821334707
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Entity Type | Organization
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Legal Business Name | RX OPTICAL LABORATORIES, INC.
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Dates
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Enumeration Date | 12/20/2012
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Last Update Date | 12/11/2017
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Provider Practice Location Address
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Address Line | 44429 ANN ARBOR ROAD
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City | PLYMOUTH TOWNSHIP
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State | MI
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Zip | 48170
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Country | US
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Telephone | 734-416-0348
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Fax | 734-416-0827
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Provider Business Mailing Address
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Address Line | 1700 S PARK ST
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City | KALAMAZOO
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State | MI
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Zip | 49001-2779
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Country | US
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Telephone | 269-342-0003
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Fax | 269-342-4284
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEPHAN JEPSON
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Credential |
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Telephone | 269-342-0003
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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 | 4901003762
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License Number State | MI
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