Provider Demographics
NPI:1821250218
Name:RICK STANTON ENTERPRISES INCORPORATED DBA LAUREN TAYLOR EYEWEAR
Entity Type:Organization
Organization Name:RICK STANTON ENTERPRISES INCORPORATED DBA LAUREN TAYLOR EYEWEAR
Other - Org Name:LAUREN TAYLOR EYEWEAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OPTICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-755-4060
Mailing Address - Street 1:1945 LAKESHORE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441
Mailing Address - Country:US
Mailing Address - Phone:231-755-4060
Mailing Address - Fax:231-755-9139
Practice Address - Street 1:1945 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441
Practice Address - Country:US
Practice Address - Phone:231-755-4060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center