Provider Demographics
NPI:1316035306
Name:ATLAS OPTICAL, INC.
Entity Type:Organization
Organization Name:ATLAS OPTICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:K
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:785-827-7757
Mailing Address - Street 1:125 N SANTA FE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-2615
Mailing Address - Country:US
Mailing Address - Phone:785-827-7757
Mailing Address - Fax:785-827-1094
Practice Address - Street 1:125 N SANTA FE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-2615
Practice Address - Country:US
Practice Address - Phone:785-827-7757
Practice Address - Fax:785-827-1094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200262620AMedicaid
KS117551OtherBCBS
KS90060Medicaid
KS90060Medicaid