Provider Demographics
NPI:1306357488
Name:OPTICAL SHOP OF WESTPORT
Entity Type:Organization
Organization Name:OPTICAL SHOP OF WESTPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:MARGHARET
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-222-7870
Mailing Address - Street 1:420 POST RD W
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-4744
Mailing Address - Country:US
Mailing Address - Phone:203-222-7870
Mailing Address - Fax:
Practice Address - Street 1:420 POST RD W
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-4744
Practice Address - Country:US
Practice Address - Phone:203-222-7870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1302332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier