Basic Information
| Provider Information | |||||||||
| NPI: | 1528233319 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AFFORDABLE OPTICAL, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2400 N CROATAN HWY | ||||||||
| Address2: | SUITE C | ||||||||
| City: | KILL DEVIL HILLS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 279489355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524412000 | ||||||||
| FaxNumber: | 2524411834 | ||||||||
| Practice Location | |||||||||
| Address1: | 2400 N CROATAN HWY | ||||||||
| Address2: | SUITE C | ||||||||
| City: | KILL DEVIL HILLS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 279489355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524412000 | ||||||||
| FaxNumber: | 2524411834 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2008 | ||||||||
| LastUpdateDate: | 03/18/2011 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | GARY | ||||||||
| AuthorizedOfficialMiddleName: | STEVEN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/OPTICIAN | ||||||||
| AuthorizedOfficialTelephone: | 2524412000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BC3200X | 1469 | NC | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment |
No ID Information.