Provider Demographics
NPI:1124573712
Name:CARLSON OPTICAL INC.
Entity Type:Organization
Organization Name:CARLSON OPTICAL INC.
Other - Org Name:COMMERCIAL OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-344-0219
Mailing Address - Street 1:513 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-2813
Mailing Address - Country:US
Mailing Address - Phone:402-344-0219
Mailing Address - Fax:402-341-4917
Practice Address - Street 1:513 S 13TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-2813
Practice Address - Country:US
Practice Address - Phone:402-344-0219
Practice Address - Fax:402-341-4917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty