Provider Demographics
NPI:1033606728
Name:ASPIRE OPTICAL CO., LLC
Entity Type:Organization
Organization Name:ASPIRE OPTICAL CO., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:FREEBORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:204-997-4842
Mailing Address - Street 1:4452 LEE LN S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-6096
Mailing Address - Country:US
Mailing Address - Phone:204-997-4842
Mailing Address - Fax:
Practice Address - Street 1:3265 45TH ST S STE 104
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7930
Practice Address - Country:US
Practice Address - Phone:701-404-5172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty