Provider Demographics
NPI:1316595390
Name:GWA OPTICAL LLC
Entity Type:Organization
Organization Name:GWA OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF VISION CLAIMS
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-292-4137
Mailing Address - Street 1:3601 SW 160TH AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-6312
Mailing Address - Country:US
Mailing Address - Phone:305-557-9004
Mailing Address - Fax:855-881-9434
Practice Address - Street 1:3646 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-4418
Practice Address - Country:US
Practice Address - Phone:773-549-3808
Practice Address - Fax:773-549-1054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-03
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier