Provider Demographics
NPI:1093867434
Name:NORTHERN OPTICAL, INC.
Entity Type:Organization
Organization Name:NORTHERN OPTICAL, INC.
Other - Org Name:EXACT EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:TOKARCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-252-1519
Mailing Address - Street 1:229 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1401
Mailing Address - Country:US
Mailing Address - Phone:712-252-1519
Mailing Address - Fax:712-252-1916
Practice Address - Street 1:1114 S STEPHENSON AVE
Practice Address - Street 2:BAY 9
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-4038
Practice Address - Country:US
Practice Address - Phone:906-774-8318
Practice Address - Fax:906-774-1603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIU332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
01242OtherVISION ONE
MIMI3140OtherEYEMED
121517OtherECPA
19204OtherNATIONAL VISION ADMIN
MI0879370003Medicare ID - Type Unspecified