Provider Demographics
NPI:1013141399
Name:OPTICAL EXPRESSIONS PLLC
Entity Type:Organization
Organization Name:OPTICAL EXPRESSIONS PLLC
Other - Org Name:OPTICAL EXPRESSIONS INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/MEMBER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-254-3169
Mailing Address - Street 1:112 W MCDOWELL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85003
Mailing Address - Country:US
Mailing Address - Phone:602-254-3169
Mailing Address - Fax:602-256-7112
Practice Address - Street 1:112 W MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003
Practice Address - Country:US
Practice Address - Phone:602-254-3169
Practice Address - Fax:602-256-7112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1480152W00000X
AZ96003772152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1730150319OtherNPI
AZ1669403028OtherNPI
AZ1568529220OtherNPI
AZ1669403028OtherNPI