Provider Demographics
NPI:1134503352
Name:THE OPTICAL CENTER, INC
Entity Type:Organization
Organization Name:THE OPTICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:K
Authorized Official - Last Name:BAGGA
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:970-245-6821
Mailing Address - Street 1:1316 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-6419
Mailing Address - Country:US
Mailing Address - Phone:970-245-6821
Mailing Address - Fax:970-243-4046
Practice Address - Street 1:1316 NORTH AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-6419
Practice Address - Country:US
Practice Address - Phone:970-245-6821
Practice Address - Fax:970-243-4046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO042267650000332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier