Provider Demographics
NPI:1093438327
Name:THE OPTICAL CROSS LLC
Entity Type:Organization
Organization Name:THE OPTICAL CROSS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MCKENZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:360-438-9458
Mailing Address - Street 1:700 SLEATER KINNEY RD SE STE E
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1113
Mailing Address - Country:US
Mailing Address - Phone:360-438-9458
Mailing Address - Fax:360-485-4971
Practice Address - Street 1:700 SLEATER KINNEY RD SE STE E
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1113
Practice Address - Country:US
Practice Address - Phone:360-438-9458
Practice Address - Fax:360-485-4971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier