Provider Demographics
NPI:1528233319
Name:AFFORDABLE OPTICAL, LLC
Entity Type:Organization
Organization Name:AFFORDABLE OPTICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-441-2000
Mailing Address - Street 1:2400 N CROATAN HWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:KILL DEVIL HILLS
Mailing Address - State:NC
Mailing Address - Zip Code:27948-9355
Mailing Address - Country:US
Mailing Address - Phone:252-441-2000
Mailing Address - Fax:252-441-1834
Practice Address - Street 1:2400 N CROATAN HWY
Practice Address - Street 2:SUITE C
Practice Address - City:KILL DEVIL HILLS
Practice Address - State:NC
Practice Address - Zip Code:27948-9355
Practice Address - Country:US
Practice Address - Phone:252-441-2000
Practice Address - Fax:252-441-1834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1469332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5461780001Medicare NSC