RX OPTICAL LABORATORIES, INC.

Provider Demographics

• NPI: 1497781868
• Name: RX OPTICAL LABORATORIES, INC.
• Entity Type: Organization
• Organization Name: RX OPTICAL LABORATORIES, INC.
• Authorized Official - Title/Position: PRESIDENT
• Authorized Official - Prefix: MR
• Authorized Official - First Name: STEPHAN
• Authorized Official - Middle Name: J
• Authorized Official - Last Name: JEPSON
• Authorized Official - Phone: 269-342-0003
• Mailing Address - Street 1: 1825 SOUTH PARK ST
• Mailing Address - City: KALAMAZOO
• Mailing Address - State: MI
• Mailing Address - Zip Code: 49001-2759
• Mailing Address - Country: US
• Mailing Address - Phone: 269-342-0003
• Mailing Address - Fax: 269-342-4284
• Practice Address - Street 1: 1700 S PARK ST
• Practice Address - City: KALAMAZOO
• Practice Address - State: MI
• Practice Address - Zip Code: 49001-2759
• Practice Address - Country: US
• Practice Address - Phone: 269-342-0003
• Practice Address - Fax: 269-342-4284
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-06-25
• Last Update Date: 2017-12-08

Provider Licenses

State	License ID	Taxonomies
MI	4901003762	152W00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	152W00000X	Eye and Vision Services Providers	Optometrist		Group - Single Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
MI	900C976550	Other	BCBS OF MICHIGAN
MI	0733500033	Medicare NSC
MI	0733500003	Medicare NSC
MI	0733500004	Medicare NSC
MI	0733500012	Medicare NSC
MI	0733500021	Medicare NSC
MI	0733500035	Medicare NSC
IN	0733500036	Medicare NSC
IN	0733500041	Medicare NSC
MI	0733500044	Medicare NSC
MI	0733500046	Medicare NSC
MI	0733500006	Medicare NSC
MI	0733500008	Medicare NSC
MI	0733500011	Medicare NSC
MI	0733500023	Medicare NSC
MI	0733500026	Medicare NSC
MI	0733500028	Medicare NSC
MI	0733500029	Medicare NSC
IN	0733500038	Medicare NSC
MI	0733500042	Medicare NSC
MI	0733500005	Medicare NSC
MI	0733500007	Medicare NSC
MI	0733500016	Medicare NSC
MI	0733500020	Medicare NSC
MI	0733500001	Medicare NSC
MI	0733500002	Medicare NSC
MI	0733500010	Medicare NSC
MI	0733500037	Medicare NSC
MI	0733500040	Medicare NSC
MI	0733500047	Medicare NSC
MI	0733500013	Medicare NSC
MI	0733500014	Medicare NSC
MI	0733500022	Medicare NSC
MI	0733500025	Medicare NSC
MI	0733500030	Medicare NSC
MI	900C976550	Other	BCBS OF MICHIGAN
MI	0733500018	Medicare NSC
MI	0733500019	Medicare NSC
MI	0733500024	Medicare NSC
MI	0733500043	Medicare NSC
MI	0733500045	Medicare NSC
MI	0733500017	Medicare NSC
MI	0733500027	Medicare NSC
MI	0733500031	Medicare NSC
MI	0733500034	Medicare NSC
MI	0733500039	Medicare NSC
MI	0733500003	Medicare NSC