Organization
OPTICAL SHOPPE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KERRY J PAUMEN ABOC (OWNER/OPTICIAN)
(970) 565-1580
Entity
Organization
Contact information
Practice address
48 E MAIN ST, CORTEZ, CO 81321-3209
(970) 565-1580
(970) 565-8203
Mailing address
48 E MAIN ST, CORTEZ, CO 81321-3209
(970) 565-1580
(970) 565-8203
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08-003899
—
CO
Enumeration date
06/09/2016
Last updated
06/09/2016
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