Provider Demographics
NPI:1558642702
Name:SCUBA OPTICS INC
Entity Type:Organization
Organization Name:SCUBA OPTICS INC
Other - Org Name:DISCOUNT EYEWEAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MASTER OPTICIAN/ OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:KLOMANN
Authorized Official - Suffix:
Authorized Official - Credentials:ABOM, NCLE
Authorized Official - Phone:815-626-7272
Mailing Address - Street 1:1405 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK FALLS
Mailing Address - State:IL
Mailing Address - Zip Code:61071-2814
Mailing Address - Country:US
Mailing Address - Phone:815-626-7272
Mailing Address - Fax:815-625-9735
Practice Address - Street 1:1405 8TH AVE
Practice Address - Street 2:
Practice Address - City:ROCK FALLS
Practice Address - State:IL
Practice Address - Zip Code:61071-2814
Practice Address - Country:US
Practice Address - Phone:815-626-7272
Practice Address - Fax:815-625-9735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty