Provider Demographics
NPI:1194099093
Name:PARTNERS OPTICAL SUPPLY INC
Entity type:Organization
Organization Name:PARTNERS OPTICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:ALVIE
Authorized Official - Last Name:MOATS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-297-7733
Mailing Address - Street 1:159 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-3128
Mailing Address - Country:US
Mailing Address - Phone:330-297-7733
Mailing Address - Fax:330-297-0170
Practice Address - Street 1:159 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-3128
Practice Address - Country:US
Practice Address - Phone:330-297-7733
Practice Address - Fax:330-297-0170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3555 T1593152W00000X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty