Provider Demographics
NPI:1417141805
Name:MASTER OPTICS OPTICAL
Entity Type:Organization
Organization Name:MASTER OPTICS OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
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:OS
Authorized Official - Phone:972-243-3373
Mailing Address - Street 1:3128 FOREST LANE
Mailing Address - Street 2:252
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234
Mailing Address - Country:US
Mailing Address - Phone:972-243-3373
Mailing Address - Fax:972-243-3373
Practice Address - Street 1:3128 FOREST LN
Practice Address - Street 2:252
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:972-243-3373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NOT REQUIRED305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service