Provider Demographics
NPI:1700179439
Name:OPTICAL WORLD, INC
Entity Type:Organization
Organization Name:OPTICAL WORLD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LADAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-544-3000
Mailing Address - Street 1:1054 SANTA ROSA PLZ
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-6345
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1054 SANTA ROSA PLZ
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-6345
Practice Address - Country:US
Practice Address - Phone:707-544-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty