Provider Demographics
NPI:1831197409
Name:MAYER OPTICAL SHOP, INC.
Entity type:Organization
Organization Name:MAYER OPTICAL SHOP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:OTTO
Authorized Official - Middle Name:P
Authorized Official - Last Name:MAYER
Authorized Official - Suffix:JR
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:651-770-2975
Mailing Address - Street 1:1736 COPE AVE E
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-2610
Mailing Address - Country:US
Mailing Address - Phone:651-770-2975
Mailing Address - Fax:651-748-1452
Practice Address - Street 1:1736 COPE AVE E
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-2610
Practice Address - Country:US
Practice Address - Phone:651-770-2975
Practice Address - Fax:651-748-1452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0141410001Medicare NSC