Provider Demographics
NPI:1013231968
Name:PRO FIT OPTIX
Entity Type:Organization
Organization Name:PRO FIT OPTIX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-251-4333
Mailing Address - Street 1:512 E DALLAS RD
Mailing Address - Street 2:STE 200
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-7660
Mailing Address - Country:US
Mailing Address - Phone:817-251-4333
Mailing Address - Fax:
Practice Address - Street 1:512 E DALLAS RD
Practice Address - Street 2:STE 200
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-7660
Practice Address - Country:US
Practice Address - Phone:817-251-4333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier