Provider Demographics
NPI:1699742999
Name:DIRECT OPTICAL LLC
Entity type:Organization
Organization Name:DIRECT OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:IRA
Authorized Official - Last Name:CHAIKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-553-8270
Mailing Address - Street 1:29325 ORCHARD LAKE ROAD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334
Mailing Address - Country:US
Mailing Address - Phone:248-553-8270
Mailing Address - Fax:248-553-8185
Practice Address - Street 1:29325 ORCHARD LAKE ROAD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334
Practice Address - Country:US
Practice Address - Phone:248-553-8270
Practice Address - Fax:248-553-8183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Not Answered332H00000XSuppliersEyewear SupplierGroup - Single Specialty