Provider Demographics
NPI:1700145133
Name:FSO, INC.
Entity Type:Organization
Organization Name:FSO, INC.
Other - Org Name:FT. SAM HOUSTON OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-828-2249
Mailing Address - Street 1:2620 HARRY WURZBACH RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-5004
Mailing Address - Country:US
Mailing Address - Phone:210-828-2249
Mailing Address - Fax:210-828-2599
Practice Address - Street 1:2620 HARRY WURZBACH RD
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-5004
Practice Address - Country:US
Practice Address - Phone:210-828-2249
Practice Address - Fax:210-828-2599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-04
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier