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General NPI Number Information
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NPI Number | 1871962951
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Entity Type | Organization
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Legal Business Name | OPTICAL SHOP EQUIPMENT INC
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Dates
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Enumeration Date | 09/18/2015
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 341 NW MEDICAL LOOP SUITE 120
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City | ROSEBURG
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State | OR
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Zip | 97471-5540
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Country | US
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Telephone | 541-673-1340
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Fax | 541-672-0655
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Provider Business Mailing Address
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Address Line | 341 NW MEDICAL LOOP SUITE 120
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City | ROSEBURG
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State | OR
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Zip | 97471-5540
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Country | US
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Telephone | 541-957-7771
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Fax | 541-672-0665
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Authorized Official
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Title or Position | OWNER
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Name | ALEXANDER WILLOUGHBY
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Credential | MD
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Telephone | 541-673-1340
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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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