# WESTSIDE OPTICAL SHOP,LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962775817
- **Authorized official:** DR. LAWRENCE EDMUND ROEL MD (OWNER/PROVIDER)
- **Authorized official phone:** (864) 542-1308

## Contact information

- **Practice address:** 1413 JOHN B WHITE SR BLVD, SUITE A, SPARTANBURG, SC 29306-3995
- **Practice address phone:** (864) 587-1039
- **Practice address fax:** (864) 587-1936
- **Mailing address:** 1413 JOHN B WHITE SR BLVD, SUITE A, SPARTANBURG, SC 29306-3995
- **Mailing address phone:** (864) 587-1039
- **Mailing address fax:** (864) 587-1936

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332H00000X | Eyewear Supplier | 120021119 | SC | Yes |

## Other

- **Enumeration date:** 02/22/2012
- **Last updated:** 05/31/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1164472098 | — | SC |