Provider Demographics
NPI:1982267894
Name:NORTH OPTICAL LLC
Entity Type:Organization
Organization Name:NORTH OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MORGAN
Authorized Official - Last Name:WHEATON
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED OPTICIAN
Authorized Official - Phone:203-241-1799
Mailing Address - Street 1:93 WASHINGTON AVE UNIT 2
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2618
Mailing Address - Country:US
Mailing Address - Phone:203-241-1799
Mailing Address - Fax:207-221-9302
Practice Address - Street 1:93 WASHINGTON AVE UNIT 2
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2618
Practice Address - Country:US
Practice Address - Phone:203-241-1799
Practice Address - Fax:207-221-9302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier