Provider Demographics
NPI:1154588507
Name:PRICE OPTICAL, INC.
Entity type:Organization
Organization Name:PRICE OPTICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:MELTON
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC
Authorized Official - Phone:316-522-2115
Mailing Address - Street 1:1016 W 29TH ST S
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67217-3114
Mailing Address - Country:US
Mailing Address - Phone:316-522-2115
Mailing Address - Fax:316-522-9416
Practice Address - Street 1:1016 W 29TH ST S
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67217-3114
Practice Address - Country:US
Practice Address - Phone:316-522-2115
Practice Address - Fax:316-522-9416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies