Provider Demographics
NPI:1649338435
Name:OPTIRX INC
Entity type:Organization
Organization Name:OPTIRX INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:330-758-9759
Mailing Address - Street 1:7178 WEST BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512
Mailing Address - Country:US
Mailing Address - Phone:330-758-9759
Mailing Address - Fax:330-729-0742
Practice Address - Street 1:7178 WEST BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512
Practice Address - Country:US
Practice Address - Phone:330-758-9759
Practice Address - Fax:330-729-0742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1847SC152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0903937Medicaid