Provider Demographics
NPI:1538465117
Name:HD OPTICAL EXPRESS LLC
Entity Type:Organization
Organization Name:HD OPTICAL EXPRESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-882-2015
Mailing Address - Street 1:5735 S CEDAR ST
Mailing Address - Street 2:STE 1
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-5154
Mailing Address - Country:US
Mailing Address - Phone:517-882-2015
Mailing Address - Fax:517-882-2026
Practice Address - Street 1:5735 S CEDAR ST
Practice Address - Street 2:STE 1
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-5154
Practice Address - Country:US
Practice Address - Phone:517-882-2015
Practice Address - Fax:517-882-2026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-31
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
MIDTR-2451048332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty