Provider Demographics
NPI:1427482413
Name:PRO-OPTIX, LLC
Entity type:Organization
Organization Name:PRO-OPTIX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:BERKHEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:360-698-4948
Mailing Address - Street 1:1266 NW MIRAGE LN
Mailing Address - Street 2:R102
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8919
Mailing Address - Country:US
Mailing Address - Phone:360-698-4948
Mailing Address - Fax:360-698-4948
Practice Address - Street 1:10315 SILVERDALE WAY NW
Practice Address - Street 2:UNIT # K-7
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-7670
Practice Address - Country:US
Practice Address - Phone:360-698-4948
Practice Address - Fax:360-698-4948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA332B00000X332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier