Provider Demographics
NPI:1326084807
Name:BOB'S QUALITY EYEWEAR INC.
Entity Type:Organization
Organization Name:BOB'S QUALITY EYEWEAR INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:OPITICAN
Authorized Official - Phone:1507-457-9901
Mailing Address - Street 1:63 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-3432
Mailing Address - Country:US
Mailing Address - Phone:150-745-7990
Mailing Address - Fax:
Practice Address - Street 1:63 W 3RD ST
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-3432
Practice Address - Country:US
Practice Address - Phone:150-745-7990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty