Provider Demographics
NPI:1053330233
Name:ACCENT OPTICAL, INC.
Entity Type:Organization
Organization Name:ACCENT OPTICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:KUNDRAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-743-4320
Mailing Address - Street 1:1039 21ST ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-3415
Mailing Address - Country:US
Mailing Address - Phone:208-743-4320
Mailing Address - Fax:
Practice Address - Street 1:1039 21ST ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-3415
Practice Address - Country:US
Practice Address - Phone:208-743-4320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID0677430001Medicare NSC