Provider Demographics
NPI:1033300496
Name:PROFESSIONAL OPTICAL SERVICES
Entity Type:Organization
Organization Name:PROFESSIONAL OPTICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:ABO
Authorized Official - Phone:912-352-2953
Mailing Address - Street 1:2 E JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5810
Mailing Address - Country:US
Mailing Address - Phone:912-352-2953
Mailing Address - Fax:912-352-7946
Practice Address - Street 1:2 EAST JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5810
Practice Address - Country:US
Practice Address - Phone:912-352-2953
Practice Address - Fax:912-352-7946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1214300001Medicare UPIN