Provider Demographics
NPI:1932117520
Name:SHIAWASSEE OPTICAL ASSOCIATES
Entity Type:Organization
Organization Name:SHIAWASSEE OPTICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-723-4732
Mailing Address - Street 1:259 N STATE RD
Mailing Address - Street 2:PO BOX 1510
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-9075
Mailing Address - Country:US
Mailing Address - Phone:989-723-4732
Mailing Address - Fax:989-743-8111
Practice Address - Street 1:259 N STATE RD
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-9075
Practice Address - Country:US
Practice Address - Phone:989-723-4732
Practice Address - Fax:989-743-8111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIHW040772332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540G80269OtherH PROVIDER NUMBER
MI540G80269OtherBCBS PROVIDER NUMBER
MI4337190001Medicare ID - Type UnspecifiedPROVIDER NUMBER