Provider Demographics
NPI:1528108644
Name:FRAME FACTORY OPTICAL
Entity type:Organization
Organization Name:FRAME FACTORY OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MINDERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:509-624-5277
Mailing Address - Street 1:628 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2518
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:628 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2518
Practice Address - Country:US
Practice Address - Phone:509-624-5277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601998700332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAA4375OtherPREMERA SUBMITTER ID
WAA4375OtherSECURE TRANSPORT SUBMIT I
WAA4375OtherSECURE TRANSPORT SUBMIT I