Provider Demographics
NPI:1053503003
Name:SUBURBAN OPTICIANS, INC.
Entity Type:Organization
Organization Name:SUBURBAN OPTICIANS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-565-2500
Mailing Address - Street 1:6720 REGENTS BLVD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-5400
Mailing Address - Country:US
Mailing Address - Phone:253-565-2500
Mailing Address - Fax:253-564-5637
Practice Address - Street 1:6720 REGENTS BLVD
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-5400
Practice Address - Country:US
Practice Address - Phone:253-565-2500
Practice Address - Fax:253-564-5637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0672260001Medicare NSC