Provider Demographics
NPI:1346541711
Name:MASTER OPTICS OPITCAL INC
Entity Type:Organization
Organization Name:MASTER OPTICS OPITCAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADDA
Authorized Official - Middle Name:O
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-243-3373
Mailing Address - Street 1:3128 FOREST LN
Mailing Address - Street 2:SUITE 252
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7726
Mailing Address - Country:US
Mailing Address - Phone:972-243-3373
Mailing Address - Fax:
Practice Address - Street 1:3128 FOREST LN
Practice Address - Street 2:SUITE 252
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7726
Practice Address - Country:US
Practice Address - Phone:972-243-3373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL8710421332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier