Provider Demographics
NPI:1346412863
Name:PHYSICIANS OPTICAL SERVICE INC
Entity Type:Organization
Organization Name:PHYSICIANS OPTICAL SERVICE 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:JOSEPH
Authorized Official - Last Name:LOOTENS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:537-635-1333
Mailing Address - Street 1:1705 CHRISTY DR
Mailing Address - Street 2:STE 103
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65101-5195
Mailing Address - Country:US
Mailing Address - Phone:573-635-1333
Mailing Address - Fax:
Practice Address - Street 1:1705 CHRISTY DR
Practice Address - Street 2:STE 103
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-5195
Practice Address - Country:US
Practice Address - Phone:573-635-1333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0641880001Medicare NSC