Provider Demographics
NPI:1841441656
Name:PAYLESS OPTICAL OUTLETS, INC
Entity type:Organization
Organization Name:PAYLESS OPTICAL OUTLETS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:225-753-0498
Mailing Address - Street 1:5214 CLAYCUT RD.
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-7125
Mailing Address - Country:US
Mailing Address - Phone:225-753-0498
Mailing Address - Fax:225-753-0498
Practice Address - Street 1:622 15TH STREET E.
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404
Practice Address - Country:US
Practice Address - Phone:205-750-0262
Practice Address - Fax:205-750-0262
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAYLESS OPTICAL OUTLETS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty