Provider Demographics
NPI:1720126774
Name:DOWNTOWN OPTICAL SHOPPE, INC.
Entity Type:Organization
Organization Name:DOWNTOWN OPTICAL SHOPPE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-396-1205
Mailing Address - Street 1:204 S RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-3143
Mailing Address - Country:US
Mailing Address - Phone:616-396-1205
Mailing Address - Fax:616-396-9442
Practice Address - Street 1:204 S RIVER AVE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-3143
Practice Address - Country:US
Practice Address - Phone:616-396-1205
Practice Address - Fax:616-396-9442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900G07607OtherBLUECROSSBLUESHIELD OF MI
MI4301790001Medicare ID - Type Unspecified