Provider Demographics
NPI:1497293542
Name:MORRIS OPTICAL INC
Entity Type:Organization
Organization Name:MORRIS OPTICAL INC
Other - Org Name:WOW WINKS ON WEBSTER OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-572-9500
Mailing Address - Street 1:521 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-2429
Mailing Address - Country:US
Mailing Address - Phone:434-572-9500
Mailing Address - Fax:434-575-1333
Practice Address - Street 1:521 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-2429
Practice Address - Country:US
Practice Address - Phone:434-572-9500
Practice Address - Fax:434-575-1333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier