Provider Demographics
NPI:1811131956
Name:U.S. OPTICAL
Entity type:Organization
Organization Name:U.S. OPTICAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HARLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RIPS
Authorized Official - Suffix:
Authorized Official - Credentials:DISPENSING OPTICIAN
Authorized Official - Phone:402-551-9541
Mailing Address - Street 1:325 N 72ND ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3605
Mailing Address - Country:US
Mailing Address - Phone:402-551-9541
Mailing Address - Fax:402-551-9606
Practice Address - Street 1:2346 S CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-2972
Practice Address - Country:US
Practice Address - Phone:417-883-5816
Practice Address - Fax:417-883-6924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
No332900000XSuppliersNon-Pharmacy Dispensing Site