Organization
NORTHPORT OPTICAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARL W. ELSNER (MANAGER)
(573) 221-2646
Entity
Organization
Contact information
Practice address
3 NORTHPORT PLZ, HANNIBAL, MO 63401-2269
(573) 221-2646
(573) 221-4479
Mailing address
3 NORTHPORT PLZ, HANNIBAL, MO 63401-2269
(573) 221-2646
(573) 221-4479
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
320082704
—
MO
Enumeration date
11/30/2006
Last updated
11/17/2009
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