Provider Demographics
NPI:1245795574
Name:PRISMOID OPTICAL LABORATORY, INC DBA BEC'S SPECS
Entity Type:Organization
Organization Name:PRISMOID OPTICAL LABORATORY, INC DBA BEC'S SPECS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:360-417-1244
Mailing Address - Street 1:PO BOX 774
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-0134
Mailing Address - Country:US
Mailing Address - Phone:360-417-1244
Mailing Address - Fax:360-417-1245
Practice Address - Street 1:216 E 5TH ST STE A
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-3008
Practice Address - Country:US
Practice Address - Phone:360-417-1244
Practice Address - Fax:360-417-1245
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEC'S SPECS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty