Provider Demographics
NPI:1780896332
Name:BSA INDUSTRIES, INC.
Entity type:Organization
Organization Name:BSA INDUSTRIES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DELBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOTHES
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:614-310-1820
Mailing Address - Street 1:6510 HUNTLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-1012
Mailing Address - Country:US
Mailing Address - Phone:614-846-5750
Mailing Address - Fax:614-846-6063
Practice Address - Street 1:6510 HUNTLEY ROAD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-1012
Practice Address - Country:US
Practice Address - Phone:614-846-5750
Practice Address - Fax:614-846-6063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0145006Medicaid