Provider Demographics
NPI:1093387995
Name:OPTIC OPTIONS VISION PRODUCTS INC
Entity Type:Organization
Organization Name:OPTIC OPTIONS VISION PRODUCTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SHASHATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-414-3513
Mailing Address - Street 1:1095 ROSEVILLE SQ
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-2809
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1095 ROSEVILLE SQ
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-2809
Practice Address - Country:US
Practice Address - Phone:916-782-9985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000OtherOPTICAL