Provider Demographics
NPI:1457373409
Name:MYOPTICS INC
Entity Type:Organization
Organization Name:MYOPTICS INC
Other - Org Name:MYOPTICS EYEWEAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BILLIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:540-639-4214
Mailing Address - Street 1:1073 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24141-1747
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1073 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141-1747
Practice Address - Country:US
Practice Address - Phone:540-639-4214
Practice Address - Fax:540-639-9768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101 001734332B00000X
VA1101001402332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVA1734OtherEYEMED PIN #
VA208428OtherANTHEM
VA6576OtherDAVIS VISION PANEL #
VA009280294Medicaid
VA780102OtherANTHEM PIN #
VAVA1402OtherEYEMED PIN#
VAVA1734OtherEYEMED PIN #