Provider Demographics
NPI:1043415722
Name:HANS CUSTOM OPTIK, INC.
Entity Type:Organization
Organization Name:HANS CUSTOM OPTIK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HANS
Authorized Official - Middle Name:W
Authorized Official - Last Name:FIEBIG
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:323-462-5195
Mailing Address - Street 1:212 N LARCHMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-3707
Mailing Address - Country:US
Mailing Address - Phone:323-462-5195
Mailing Address - Fax:323-462-5180
Practice Address - Street 1:212 N LARCHMONT BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3707
Practice Address - Country:US
Practice Address - Phone:323-462-5195
Practice Address - Fax:323-462-5180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD3775156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0839810001Medicare NSC