Provider Demographics
NPI:1225159213
Name:TWELVE THIRTY OPTICAL, INC.
Entity Type:Organization
Organization Name:TWELVE THIRTY OPTICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CONTACT LENS TECHNICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:G
Authorized Official - Last Name:IRVIN
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED OPTICIAN
Authorized Official - Phone:513-829-8808
Mailing Address - Street 1:1117 MAGIE AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-1823
Mailing Address - Country:US
Mailing Address - Phone:513-829-8808
Mailing Address - Fax:513-829-5305
Practice Address - Street 1:1117 MAGIE AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-1823
Practice Address - Country:US
Practice Address - Phone:513-829-8808
Practice Address - Fax:513-829-5305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSC1577332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH23706OtherSPECTERA
OH30569OtherDAVIS VISION
OHOH1577OtherEYE MED
OH141502OtherCOLE MANAGED VISION