Provider Demographics
NPI:1124333802
Name:JASSO INC DBA SOONER OPTICAL
Entity type:Organization
Organization Name:JASSO INC DBA SOONER OPTICAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:T
Authorized Official - Last Name:SALTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-627-6550
Mailing Address - Street 1:5067 S YALE AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-7010
Mailing Address - Country:US
Mailing Address - Phone:918-627-6550
Mailing Address - Fax:918-627-6577
Practice Address - Street 1:5067 S YALE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-7010
Practice Address - Country:US
Practice Address - Phone:918-627-6550
Practice Address - Fax:918-627-6577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier