Provider Demographics
NPI:1346408457
Name:RENOPTICS INC.
Entity Type:Organization
Organization Name:RENOPTICS INC.
Other - Org Name:SOUTHPARK OPTICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:RENFROW
Authorized Official - Suffix:
Authorized Official - Credentials:RO
Authorized Official - Phone:704-364-4300
Mailing Address - Street 1:4400 SHARON RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-3531
Mailing Address - Country:US
Mailing Address - Phone:704-364-4300
Mailing Address - Fax:
Practice Address - Street 1:4400 SHARON RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-3531
Practice Address - Country:US
Practice Address - Phone:704-364-4300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-26
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC692332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0872020001Medicare NSC