Provider Demographics
NPI:1376912071
Name:CGREAT LLC
Entity Type:Organization
Organization Name:CGREAT LLC
Other - Org Name:OPTICAL FASHIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:MARITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-429-2270
Mailing Address - Street 1:3617 DAYTON XENIA RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45432-2828
Mailing Address - Country:US
Mailing Address - Phone:937-429-2270
Mailing Address - Fax:937-429-5343
Practice Address - Street 1:3617 DAYTON XENIA RD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-2828
Practice Address - Country:US
Practice Address - Phone:937-429-2270
Practice Address - Fax:937-429-5344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-23
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier