Provider Demographics
NPI:1871962951
Name:OPTICAL SHOP EQUIPMENT INC
Entity type:Organization
Organization Name:OPTICAL SHOP EQUIPMENT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLOUGHBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-673-1340
Mailing Address - Street 1:341 NW MEDICAL LOOP
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-5540
Mailing Address - Country:US
Mailing Address - Phone:541-957-7771
Mailing Address - Fax:541-672-0665
Practice Address - Street 1:341 NW MEDICAL LOOP
Practice Address - Street 2:SUITE 120
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-5540
Practice Address - Country:US
Practice Address - Phone:541-673-1340
Practice Address - Fax:541-672-0655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-18
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear SupplierGroup - Single Specialty