Provider Demographics
NPI:1356607287
Name:OPTI CON INC.
Entity type:Organization
Organization Name:OPTI CON INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:PANICHELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-256-5422
Mailing Address - Street 1:725 NE 102ND AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-4065
Mailing Address - Country:US
Mailing Address - Phone:503-256-5422
Mailing Address - Fax:800-756-3451
Practice Address - Street 1:725 NE 102ND AVE
Practice Address - Street 2:SUITE C
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-4065
Practice Address - Country:US
Practice Address - Phone:503-256-5422
Practice Address - Fax:800-756-3451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment