Provider Demographics
NPI:1114354107
Name:OPTICAL GALLERY, INC.
Entity Type:Organization
Organization Name:OPTICAL GALLERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBEUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-792-7320
Mailing Address - Street 1:39400 GARFIELD RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-4096
Mailing Address - Country:US
Mailing Address - Phone:586-792-7320
Mailing Address - Fax:586-792-7515
Practice Address - Street 1:39400 GARFIELD RD
Practice Address - Street 2:SUITE 102
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-4096
Practice Address - Country:US
Practice Address - Phone:586-792-7320
Practice Address - Fax:586-792-7515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies