Provider Demographics
NPI:1497115406
Name:ALLIED OPTICAL SHOP INC.
Entity Type:Organization
Organization Name:ALLIED OPTICAL SHOP INC.
Other - Org Name:ALLIED OPTICAL SHOP INC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:MATZKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-933-0010
Mailing Address - Street 1:7405 SHALLOWFORD RD
Mailing Address - Street 2:SUITE 420
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2661
Mailing Address - Country:US
Mailing Address - Phone:423-933-0010
Mailing Address - Fax:423-855-8533
Practice Address - Street 1:7405 SHALLOWFORD RD
Practice Address - Street 2:SUITE 420
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2661
Practice Address - Country:US
Practice Address - Phone:423-933-0010
Practice Address - Fax:423-855-8533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier