Provider Demographics
NPI:1346399052
Name:OPTICAL EXPRESS, INC.
Entity Type:Organization
Organization Name:OPTICAL EXPRESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:STRAKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:864-855-6571
Mailing Address - Street 1:5823 CALHOUN MEMORIAL HWY
Mailing Address - Street 2:SUITE 2-A
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-3874
Mailing Address - Country:US
Mailing Address - Phone:864-855-6571
Mailing Address - Fax:864-855-2303
Practice Address - Street 1:5823 CALHOUN MEMORIAL HWY
Practice Address - Street 2:SUITE 2-A
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-3874
Practice Address - Country:US
Practice Address - Phone:864-855-6571
Practice Address - Fax:864-855-2303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC492152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDA9951Medicaid
SCDA9951Medicaid
SC0251940281Medicare PIN
SC0250180001Medicare NSC