Provider Demographics
NPI:1083813448
Name:THE OPTICAL SHOPPE
Entity Type:Organization
Organization Name:THE OPTICAL SHOPPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:MEREDITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:417-782-1356
Mailing Address - Street 1:2216 E 32ND STREET
Mailing Address - Street 2:SUITE 202
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-3015
Mailing Address - Country:US
Mailing Address - Phone:417-782-1356
Mailing Address - Fax:417-782-7861
Practice Address - Street 1:2216 E 32ND STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3015
Practice Address - Country:US
Practice Address - Phone:417-782-1356
Practice Address - Fax:417-782-7861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO11364068332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0668180001Medicare UPIN