Provider Demographics
NPI:1770843476
Name:THE OPTICAL SHOP
Entity Type:Organization
Organization Name:THE OPTICAL SHOP
Other - Org Name:THE OPTICAL SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:P
Authorized Official - Last Name:VERRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-253-4000
Mailing Address - Street 1:N89W16785 APPLETON AVE
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-2071
Mailing Address - Country:US
Mailing Address - Phone:262-253-4000
Mailing Address - Fax:262-253-6583
Practice Address - Street 1:N89W16785 APPLETON AVE
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-2071
Practice Address - Country:US
Practice Address - Phone:262-253-4000
Practice Address - Fax:262-253-6583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier