Provider Demographics
NPI:1497093819
Name:STRONG OPTICAL SHOP
Entity Type:Organization
Organization Name:STRONG OPTICAL SHOP
Other - Org Name:GENEVA OPTICAL
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSOCIATE DIRECTOR OF FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:HETTERICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-756-4003
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 659
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-276-3273
Mailing Address - Fax:
Practice Address - Street 1:738 PRE EMPTION RD
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-1336
Practice Address - Country:US
Practice Address - Phone:585-276-3273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-18
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier