Provider Demographics
NPI:1154635761
Name:AEROPTICS LLC
Entity Type:Organization
Organization Name:AEROPTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMPERT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:623-362-8642
Mailing Address - Street 1:20004 N 67TH AVE
Mailing Address - Street 2:C/O OPTICAL GALLERY ARIZONA
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308
Mailing Address - Country:US
Mailing Address - Phone:623-362-8642
Mailing Address - Fax:623-561-1190
Practice Address - Street 1:7071 N 138TH AV
Practice Address - Street 2:BLDG 1540
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85307
Practice Address - Country:US
Practice Address - Phone:623-362-8642
Practice Address - Fax:623-561-1190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1151152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ78064Medicare PIN