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Organization
LARRY L. MINIX DBA THE OPTICAL SHOPPE
Active
Organization
LARRY L. MINIX DBA THE OPTICAL SHOPPE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY L. MINIX OPTICIAN HIS (OWNER)
(270) 926-4933
Entity
Organization
Contact information
Practice address
1115 TAMARACK RD, SUITE 100, OWENSBORO, KY 42301-6984
(270) 926-4933
(270) 688-0627
Mailing address
1115 TAMARACK RD, SUITE 100, OWENSBORO, KY 42301-6984
(270) 926-4933
(270) 688-0627
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
NULL
156FX1800X
Optician
Primary
—
—
237700000X
Hearing Instrument Specialist
—
NULL
237700000X
Hearing Instrument Specialist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
52800315
—
KY
05
—
52903945
—
KY
Enumeration date
10/02/2006
Last updated
09/16/2009
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