Provider Demographics
NPI:1386854479
Name:OPTICAL SUPPLIERS, INC.
Entity Type:Organization
Organization Name:OPTICAL SUPPLIERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:T
Authorized Official - Last Name:SHIGEMURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-486-2933
Mailing Address - Street 1:99-1253 HALAWA VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-3281
Mailing Address - Country:US
Mailing Address - Phone:808-486-2933
Mailing Address - Fax:808-486-6458
Practice Address - Street 1:99-1253 HALAWA VALLEY ST
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3281
Practice Address - Country:US
Practice Address - Phone:808-486-2933
Practice Address - Fax:808-486-6458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HID10-38332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier