Provider Demographics
NPI:1992825426
Name:OPTICAL ELEGANCE,INC
Entity Type:Organization
Organization Name:OPTICAL ELEGANCE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SWEATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-482-2020
Mailing Address - Street 1:235 E ROWAN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-1240
Mailing Address - Country:US
Mailing Address - Phone:509-482-2020
Mailing Address - Fax:509-482-2012
Practice Address - Street 1:235 E ROWAN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1240
Practice Address - Country:US
Practice Address - Phone:509-482-2020
Practice Address - Fax:509-482-2012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0506570001OtherSTERLING OPTION ONE
WA108163OtherPREMERA BLUE CROSS
WAOP1983OtherASURIS NW HEALTH
WAWA10OtherLIFEWISE OF WASHINGTON
WAOP1983OtherASURIS NW HEALTH
WA108163OtherPREMERA BLUE CROSS