Provider Demographics
NPI:1033310180
Name:INTERSTATE OPTICAL CO., INC.
Entity Type:Organization
Organization Name:INTERSTATE OPTICAL CO., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARKETING DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-529-6097
Mailing Address - Street 1:680 LINDAIRE LN E
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-1760
Mailing Address - Country:US
Mailing Address - Phone:419-529-6800
Mailing Address - Fax:
Practice Address - Street 1:680 LINDAIRE LN E
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-1760
Practice Address - Country:US
Practice Address - Phone:419-529-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier