Provider Demographics
NPI:1255452843
Name:OPTICAL ILLUSIONS INC
Entity type:Organization
Organization Name:OPTICAL ILLUSIONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEDDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-528-7844
Mailing Address - Street 1:3160 E 17TH ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-6717
Mailing Address - Country:US
Mailing Address - Phone:208-528-7844
Mailing Address - Fax:208-528-9473
Practice Address - Street 1:3160 E 17TH ST
Practice Address - Street 2:SUITE 150
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406-6717
Practice Address - Country:US
Practice Address - Phone:208-528-7844
Practice Address - Fax:208-528-9473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier