Provider Demographics
NPI:1699958108
Name:DORLON OPTICAL LLC
Entity type:Organization
Organization Name:DORLON OPTICAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DORLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-336-1801
Mailing Address - Street 1:1077 BRANSON HILLS PKWY
Mailing Address - Street 2:SUITE N
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-9940
Mailing Address - Country:US
Mailing Address - Phone:417-336-1801
Mailing Address - Fax:417-336-1803
Practice Address - Street 1:1077 BRANSON HILLS PKWY
Practice Address - Street 2:SUITE N
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-9940
Practice Address - Country:US
Practice Address - Phone:417-336-1801
Practice Address - Fax:417-336-1803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO19975741332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier