Provider Demographics
NPI:1518033703
Name:PRECISION OPTICAL INC
Entity Type:Organization
Organization Name:PRECISION OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:ANSELMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-963-1030
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:DORAN
Mailing Address - State:VA
Mailing Address - Zip Code:24612
Mailing Address - Country:US
Mailing Address - Phone:276-963-1030
Mailing Address - Fax:276-963-5225
Practice Address - Street 1:5453 GOVERNOR GC PEERY HWY
Practice Address - Street 2:DORAN PROFESSIONAL BLDG
Practice Address - City:DORAN
Practice Address - State:VA
Practice Address - Zip Code:24612
Practice Address - Country:US
Practice Address - Phone:276-963-1030
Practice Address - Fax:276-963-5225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9280634Medicaid
VA9280634Medicaid