Provider Demographics
NPI:1477694610
Name:VAN OPTICAL
Entity Type:Organization
Organization Name:VAN OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:VANTUINEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-843-5300
Mailing Address - Street 1:5057 SPRUCEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-1844
Mailing Address - Country:US
Mailing Address - Phone:419-843-5300
Mailing Address - Fax:
Practice Address - Street 1:5307 MONROE ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-2888
Practice Address - Country:US
Practice Address - Phone:419-841-8550
Practice Address - Fax:419-843-7342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1421S156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty