Provider Demographics
NPI:1992462188
Name:MADOPTICAL
Entity type:Organization
Organization Name:MADOPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:ABO, NCLE
Authorized Official - Phone:402-639-3822
Mailing Address - Street 1:1441 MALL DR STE 400
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-4728
Mailing Address - Country:US
Mailing Address - Phone:712-256-5515
Mailing Address - Fax:
Practice Address - Street 1:1441 MALL DR STE 400
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4728
Practice Address - Country:US
Practice Address - Phone:712-256-5515
Practice Address - Fax:712-256-8093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier