Provider Demographics
NPI:1003970344
Name:REAL OPTICS INC
Entity Type:Organization
Organization Name:REAL OPTICS INC
Other - Org Name:VOGUE VISION, EYEMART OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMPLOYER
Authorized Official - Prefix:MR
Authorized Official - First Name:ISAK
Authorized Official - Middle Name:
Authorized Official - Last Name:SIVI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-244-7740
Mailing Address - Street 1:2405 INGERSOLL AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-5233
Mailing Address - Country:US
Mailing Address - Phone:515-244-7740
Mailing Address - Fax:515-244-6354
Practice Address - Street 1:2405 INGERSOLL AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-5233
Practice Address - Country:US
Practice Address - Phone:515-244-7740
Practice Address - Fax:515-244-6354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2914013Medicaid
IAD08607778Medicare PIN
IA2914013Medicaid