Organization
OLDE TYME OPTICAL
Active
Parent organization
OLDE TYME OPTICAL
Organization subpart
Yes
Provider details
NPI number
Legal business name
OLDE TYME OPTICAL
Authorized official
MR. DAVID ANTONE BLISSENBACH (OWNER)
(618) 274-2020
Entity
Organization
Contact information
Practice address
100 N. 8TH ST E., SUITE 264, E. ST. LOUIS, IL 62201
(618) 274-2020
Mailing address
100 N. 8TH ST E., SUITE 264, E. ST. LOUIS, IL 62201
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
—
Other
Enumeration date
05/07/2015
Last updated
05/07/2015
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