Provider Demographics
NPI:1952571457
Name:OPTICIANRY SERVICES, LTD.
Entity Type:Organization
Organization Name:OPTICIANRY SERVICES, LTD.
Other - Org Name:MEDICAL CENTER OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-459-1912
Mailing Address - Street 1:1308 W ANDERSON LN
Mailing Address - Street 2:SUITE C
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-1459
Mailing Address - Country:US
Mailing Address - Phone:512-459-1912
Mailing Address - Fax:512-459-1560
Practice Address - Street 1:1308 W ANDERSON LN
Practice Address - Street 2:SUITE C
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-1459
Practice Address - Country:US
Practice Address - Phone:512-459-1912
Practice Address - Fax:512-459-1560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
1055030001Medicare NSC