Provider Demographics
NPI:1285967935
Name:OPTICAL IMPRESSIONS LLC
Entity type:Organization
Organization Name:OPTICAL IMPRESSIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:RICHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-818-2020
Mailing Address - Street 1:8096 RIVERS AVE STE A
Mailing Address - Street 2:
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9243
Mailing Address - Country:US
Mailing Address - Phone:843-818-2020
Mailing Address - Fax:843-818-2379
Practice Address - Street 1:1112 E N. MAIN STREET
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-7315
Practice Address - Country:US
Practice Address - Phone:843-261-2020
Practice Address - Fax:843-261-2080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC905156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty