Provider Demographics
NPI:1982883716
Name:US OPTICAL INC
Entity Type:Organization
Organization Name:US OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:HANI
Authorized Official - Middle Name:
Authorized Official - Last Name:SADDIC
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:951-526-3751
Mailing Address - Street 1:5230 NORTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-2467
Mailing Address - Country:US
Mailing Address - Phone:216-332-1711
Mailing Address - Fax:
Practice Address - Street 1:29574 HAZEL GLEN RD
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-6798
Practice Address - Country:US
Practice Address - Phone:951-526-3751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS4217332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2502876Medicaid