Provider Demographics
NPI:1366478570
Name:ASHLAND OPTICAL CO INC
Entity Type:Organization
Organization Name:ASHLAND OPTICAL CO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:GUSSLER
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-325-3266
Mailing Address - Street 1:613 23RD ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101
Mailing Address - Country:US
Mailing Address - Phone:606-325-3266
Mailing Address - Fax:606-325-3266
Practice Address - Street 1:613 23RD ST
Practice Address - Street 2:SUITE 140
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101
Practice Address - Country:US
Practice Address - Phone:606-325-3266
Practice Address - Fax:606-325-3266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY672332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0741970001Medicare ID - Type Unspecified