Provider Demographics
NPI:1891846903
Name:LEWISTON OPTICAL L.L.C.
Entity Type:Organization
Organization Name:LEWISTON OPTICAL L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:RANA
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:208-746-8100
Mailing Address - Street 1:1313 G ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-1934
Mailing Address - Country:US
Mailing Address - Phone:208-746-8100
Mailing Address - Fax:208-746-8105
Practice Address - Street 1:1313 G ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-1934
Practice Address - Country:US
Practice Address - Phone:208-746-8100
Practice Address - Fax:208-746-8105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID5960960001Medicare NSC