Provider Demographics
NPI:1215667357
Name:OSCODA OPTICAL INC.
Entity type:Organization
Organization Name:OSCODA OPTICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:RUEMENAPP
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:989-362-9546
Mailing Address - Street 1:1691 E US 23 STE 2
Mailing Address - Street 2:
Mailing Address - City:EAST TAWAS
Mailing Address - State:MI
Mailing Address - Zip Code:48730-9337
Mailing Address - Country:US
Mailing Address - Phone:989-362-9546
Mailing Address - Fax:989-362-9567
Practice Address - Street 1:1691 E US 23 STE 2
Practice Address - Street 2:
Practice Address - City:EAST TAWAS
Practice Address - State:MI
Practice Address - Zip Code:48730-9337
Practice Address - Country:US
Practice Address - Phone:989-362-9546
Practice Address - Fax:989-362-9567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty