Provider Demographics
NPI:1598915175
Name:S & A OPTICAL
Entity type:Organization
Organization Name:S & A OPTICAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:NASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-534-4700
Mailing Address - Street 1:309 S OAKLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76103-3762
Mailing Address - Country:US
Mailing Address - Phone:817-534-4700
Mailing Address - Fax:817-531-2534
Practice Address - Street 1:309 S OAKLAND BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76103-3762
Practice Address - Country:US
Practice Address - Phone:817-534-4700
Practice Address - Fax:817-531-2534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019759201Medicaid