Provider Demographics
NPI:1558868158
Name:MADSCIENTIST OPTICAL LABORATROY LLC
Entity Type:Organization
Organization Name:MADSCIENTIST OPTICAL LABORATROY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:S
Authorized Official - Last Name:NAVARRO
Authorized Official - Suffix:
Authorized Official - Credentials:OD/OWNER
Authorized Official - Phone:956-383-5581
Mailing Address - Street 1:2301 S US HIGHWAY 281
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-3712
Mailing Address - Country:US
Mailing Address - Phone:956-383-5581
Mailing Address - Fax:956-381-1218
Practice Address - Street 1:2301 S US HIGHWAY 281
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-3712
Practice Address - Country:US
Practice Address - Phone:956-383-5581
Practice Address - Fax:956-381-1218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty