Organization
COFFEYVILLE OPTIC SHOP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA M DALE (OWNER)
(620) 870-4511
Entity
Organization
Contact information
Practice address
2205 W 8TH ST STE B, COFFEYVILLE, KS 67337-2950
(620) 251-0050
Mailing address
4573 CR 2875, COFFEYVILLE, KS 67337-7962
(620) 870-4511
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
—
Other
Enumeration date
10/29/2021
Last updated
10/29/2021
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