Provider Demographics
NPI:1215283247
Name:OPTICAL LAND,LLC
Entity type:Organization
Organization Name:OPTICAL LAND,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAE
Authorized Official - Middle Name:H
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-281-1001
Mailing Address - Street 1:153 E 4370 S
Mailing Address - Street 2:SUITE 7
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-2624
Mailing Address - Country:US
Mailing Address - Phone:801-281-1001
Mailing Address - Fax:
Practice Address - Street 1:153 E 4370 S
Practice Address - Street 2:SUITE 7
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107
Practice Address - Country:US
Practice Address - Phone:801-281-1001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-27
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty