Optic Shop, LLC.

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

Legal business name

OPTIC SHOP, LLC.

Practice address

2205 W 8TH St
Coffeyville, KS 67337-2936

Phone

(620) 251-0050

Fax

(620) 688-6055

NPI assigned

Dec 20, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Heath V Haffener, D.C.

Title

Part Owner

Phone

(620) 252-8047

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1545264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559692800000",
    "number": "1396217931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2205 W 8TH ST",
            "city": "COFFEYVILLE",
            "state": "KS",
            "postal_code": "673372936",
            "telephone_number": "620-251-0050",
            "fax_number": "620-688-6055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2205 W 8TH ST",
            "city": "COFFEYVILLE",
            "state": "KS",
            "postal_code": "673372936",
            "telephone_number": "620-251-0050",
            "fax_number": "620-688-6055"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1411 W 4th St",
            "address_purpose": "LOCATION",
            "city": "Coffeyville",
            "state": "KS",
            "postal_code": "673373341",
            "country_code": "US",
            "telephone_number": "620-251-0050",
            "fax_number": "620-251-0050",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OPTIC SHOP, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-20",
        "last_updated": "2019-06-05",
        "status": "A",
        "authorized_official_last_name": "HAFFENER",
        "authorized_official_first_name": "HEATH",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "PART OWNER",
        "authorized_official_telephone_number": "620-252-8047",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Eyewear Supplier in Coffeyville, KS
• Providers in Coffeyville, KS by specialty
• Eyewear Supplier in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.