Provider Demographics
NPI:1104153303
Name:HOYA OPTICAL LABS OF AMERICA, INC.
Entity type:Organization
Organization Name:HOYA OPTICAL LABS OF AMERICA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF INTERNAL AUDIT & COMPLI
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-524-5448
Mailing Address - Street 1:651 E CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-6403
Mailing Address - Country:US
Mailing Address - Phone:972-221-4141
Mailing Address - Fax:972-219-2786
Practice Address - Street 1:2156 SOUTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-1893
Practice Address - Country:US
Practice Address - Phone:614-801-0500
Practice Address - Fax:614-801-0511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-09
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX752919956332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1527075Medicaid