Provider Demographics
NPI:1568590081
Name:OPTICAL PRESCRIPTION SERVICE, INC.
Entity Type:Organization
Organization Name:OPTICAL PRESCRIPTION SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILFRED
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:JR
Authorized Official - Credentials:CERTIFIED OPTICIAN
Authorized Official - Phone:325-655-9998
Mailing Address - Street 1:401 W HIGHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76903-7314
Mailing Address - Country:US
Mailing Address - Phone:325-655-9998
Mailing Address - Fax:325-653-1350
Practice Address - Street 1:401 W HIGHLAND BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-7314
Practice Address - Country:US
Practice Address - Phone:325-655-9998
Practice Address - Fax:325-653-1350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXME=========54OtherFEDERAL TAX ID #
TXME=========54OtherFEDERAL TAX ID #