Provider Demographics
NPI:1487821435
Name:V: OPTICAL LABORATORY, INC.
Entity Type:Organization
Organization Name:V: OPTICAL LABORATORY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SOMPHAVANH
Authorized Official - Middle Name:
Authorized Official - Last Name:VINAVONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-888-3772
Mailing Address - Street 1:2234 PALMYRA RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1322
Mailing Address - Country:US
Mailing Address - Phone:229-888-3772
Mailing Address - Fax:229-888-3688
Practice Address - Street 1:2234 PALMYRA RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1322
Practice Address - Country:US
Practice Address - Phone:229-888-3772
Practice Address - Fax:229-888-3688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier