Organization
RX OPTICAL LABORATORIES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHAN JEPSON (PRESIDENT)
(269) 342-0003
Entity
Organization
Contact information
Practice address
2000 E BELTLINE AVE NE, GRAND RAPIDS, MI 49525-9716
(616) 608-0466
(616) 608-0467
Mailing address
1825 S PARK ST, KALAMAZOO, MI 49001-2779
(269) 342-0003
(269) 342-4284
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901003762
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1750830261
—
MI
Enumeration date
09/26/2016
Last updated
12/11/2017
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