Provider Demographics
NPI:1760054803
Name:OPTICAL EXPRESS
Entity Type:Organization
Organization Name:OPTICAL EXPRESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:STRAKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:865-855-6571
Mailing Address - Street 1:1812 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-4729
Mailing Address - Country:US
Mailing Address - Phone:864-316-9053
Mailing Address - Fax:
Practice Address - Street 1:5823 CALHOUN MEMORIAL HWY STE 2A
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-3874
Practice Address - Country:US
Practice Address - Phone:864-855-6571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty