Provider Demographics
NPI: | 1417038423 |
---|---|
Name: | STEIN OPTICAL INC |
Entity Type: | Organization |
Organization Name: | STEIN OPTICAL INC |
Other - Org Name: | STEIN OPTICAL |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | OFFICER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | DOUG |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | NEWCOM |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 210-524-6700 |
Mailing Address - Street 1: | PO BOX 846309 |
Mailing Address - Street 2: | |
Mailing Address - City: | DALLAS |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75284-6309 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 210-524-6663 |
Mailing Address - Fax: | 210-524-6587 |
Practice Address - Street 1: | 5530 N PORT WASHINGTON RD |
Practice Address - Street 2: | |
Practice Address - City: | MILWAUKEE |
Practice Address - State: | WI |
Practice Address - Zip Code: | 53217-4920 |
Practice Address - Country: | US |
Practice Address - Phone: | 414-332-1114 |
Practice Address - Fax: | 414-332-5169 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-10-17 |
Last Update Date: | 2008-08-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 332H00000X | Suppliers | Eyewear Supplier |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
WI | 38716600 | Medicaid | |
WI | 1306360007 | Medicare NSC |