Provider Demographics
NPI:1720481484
Name:OPTICAL MANAGEMENT SERVICES, LLC
Entity Type:Organization
Organization Name:OPTICAL MANAGEMENT SERVICES, LLC
Other - Org Name:RIVERFRONT OPTICAL EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-215-6748
Mailing Address - Street 1:3200 CABARET TRL S
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-2202
Mailing Address - Country:US
Mailing Address - Phone:989-790-5005
Mailing Address - Fax:989-790-9179
Practice Address - Street 1:3200 CABARET TRL S
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2202
Practice Address - Country:US
Practice Address - Phone:989-790-5005
Practice Address - Fax:989-790-9179
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DA VINCI EQUITY GROUP, LC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-08
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC001417168152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty