Provider Demographics
NPI:1558427740
Name:THE OPTICAL CENTER
Entity Type:Organization
Organization Name:THE OPTICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHOSSOW
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC
Authorized Official - Phone:641-753-5042
Mailing Address - Street 1:116 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-5844
Mailing Address - Country:US
Mailing Address - Phone:641-753-5042
Mailing Address - Fax:641-753-5292
Practice Address - Street 1:116 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-5844
Practice Address - Country:US
Practice Address - Phone:641-753-5042
Practice Address - Fax:641-753-5292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA22889OtherWELLMARK BLUE CROSS & BLU
IA32820OtherAVESIS
IA0229401Medicaid
IA0229401Medicaid