Provider Demographics
NPI:1780221515
Name:FASHION FORWARD OPTICAL
Entity Type:Organization
Organization Name:FASHION FORWARD OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-686-0908
Mailing Address - Street 1:4910 DODGE ST STE 107
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68132-2978
Mailing Address - Country:US
Mailing Address - Phone:402-686-0908
Mailing Address - Fax:402-660-2672
Practice Address - Street 1:4910 DODGE ST STE 107
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68132-2978
Practice Address - Country:US
Practice Address - Phone:402-686-0908
Practice Address - Fax:402-660-2672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty