Provider Demographics
NPI:1154528883
Name:OTTAWAHILLS OPTICAL INC
Entity type:Organization
Organization Name:OTTAWAHILLS OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-292-0004
Mailing Address - Street 1:3020 HARTLEY RD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-8231
Mailing Address - Country:US
Mailing Address - Phone:904-292-0004
Mailing Address - Fax:904-292-0005
Practice Address - Street 1:3020 HARTLEY RD
Practice Address - Street 2:SUITE 190
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-8231
Practice Address - Country:US
Practice Address - Phone:904-292-0004
Practice Address - Fax:904-292-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD7840OtherBLUE CROSS BLUE SHIELD
FLD7840OtherBLUE CROSS BLUE SHIELD