Provider Demographics
NPI:1568596898
Name:CRAFTSMEN OPTICAL IN.
Entity Type:Organization
Organization Name:CRAFTSMEN OPTICAL IN.
Other - Org Name:EYEGLASS OUTLET & SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:CLIFFORD
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:231-946-5809
Mailing Address - Street 1:1077 W SOUTH AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-4737
Mailing Address - Country:US
Mailing Address - Phone:231-946-5809
Mailing Address - Fax:231-946-5820
Practice Address - Street 1:1077 W SOUTH AIRPORT RD
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-4737
Practice Address - Country:US
Practice Address - Phone:231-946-5809
Practice Address - Fax:231-946-5820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier