Provider Demographics
NPI:1225075039
Name:OPTIQUE 20/20, INC-GREEN RIVER
Entity Type:Organization
Organization Name:OPTIQUE 20/20, INC-GREEN RIVER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORP
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMESQ
Authorized Official - Middle Name:R
Authorized Official - Last Name:BYARS
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:307-875-4040
Mailing Address - Street 1:175 RIVERVIEW DR
Mailing Address - Street 2:SUITE E & F
Mailing Address - City:GREEN RIVER
Mailing Address - State:WY
Mailing Address - Zip Code:82935-4811
Mailing Address - Country:US
Mailing Address - Phone:307-875-4040
Mailing Address - Fax:
Practice Address - Street 1:175 RIVERVIEW DR
Practice Address - Street 2:SUITE E & F
Practice Address - City:GREEN RIVER
Practice Address - State:WY
Practice Address - Zip Code:82935-4811
Practice Address - Country:US
Practice Address - Phone:307-875-4040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier