Provider Demographics
NPI:1760571558
Name:OPTICAL STYLE BAR INC
Entity Type:Organization
Organization Name:OPTICAL STYLE BAR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVEY
Authorized Official - Suffix:II
Authorized Official - Credentials:LO
Authorized Official - Phone:860-643-1191
Mailing Address - Street 1:763 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-5102
Mailing Address - Country:US
Mailing Address - Phone:860-643-1191
Mailing Address - Fax:
Practice Address - Street 1:763 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-5102
Practice Address - Country:US
Practice Address - Phone:860-643-1191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1230156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0416330001Medicare NSC
CT0416330001Medicare ID - Type Unspecified