Provider Demographics
NPI:1750318648
Name:RAPHTIS OPTICAL INC.
Entity Type:Organization
Organization Name:RAPHTIS OPTICAL INC.
Other - Org Name:BALIAN OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ARETAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-651-6122
Mailing Address - Street 1:432 W. UNIVERSITY DR.
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307
Mailing Address - Country:US
Mailing Address - Phone:248-651-6122
Mailing Address - Fax:248-651-4825
Practice Address - Street 1:432 W. UNIVERSITY DR.
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307
Practice Address - Country:US
Practice Address - Phone:248-651-6122
Practice Address - Fax:248-651-4825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
4395160001Medicare NSC