Provider Demographics
NPI:1346204906
Name:DIRECT OPTICAL CENTER INC
Entity Type:Organization
Organization Name:DIRECT OPTICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:706-324-7221
Mailing Address - Street 1:1030 13TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-2240
Mailing Address - Country:US
Mailing Address - Phone:706-327-3937
Mailing Address - Fax:706-596-6658
Practice Address - Street 1:1030 13TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-2240
Practice Address - Country:US
Practice Address - Phone:706-327-3937
Practice Address - Fax:706-596-6658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherEIN