Active NPI
Olde Tyme Optical
- Optician
- E St Louis, IL
National Provider Identifier
1659759918
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- Legal business name
- OLDE TYME OPTICAL
- Practice address
- 100 N. 8TH St E.
Suite 264
E. St. Louis, IL 62201 - Phone
- (618) 274-2020
- NPI assigned
- May 7, 2015
- Last updated
- May 7, 2015
- Organization subpart
- Yes
- Parent organization
- OLDE TYME OPTICAL
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. David Antone Blissenbach
- Title
- Owner
- Phone
- (618) 274-2020
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | NU | Primary |
Addresses
Primary practice location
100 N. 8TH St E.
Suite 264
E. St. Louis, IL 62201
Mailing address
100 N. 8TH St E.
Suite 264
E. St. Louis, IL 62201
National Provider Directory
National Provider Directory- Part of
- Olde Tyme Optical
Locations
100 N 8th St
Ste 264
East Saint Louis, IL 62201
Phone (618) 274-2020
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1430956800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1430956800000",
"number": "1659759918",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 N. 8TH ST E.",
"address_2": "SUITE 264",
"city": "E. ST. LOUIS",
"state": "IL",
"postal_code": "62201"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 N. 8TH ST E.",
"address_2": "SUITE 264",
"city": "E. ST. LOUIS",
"state": "IL",
"postal_code": "62201",
"telephone_number": "618-274-2020"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "OLDE TYME OPTICAL",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "OLDE TYME OPTICAL",
"enumeration_date": "2015-05-07",
"last_updated": "2015-05-07",
"status": "A",
"authorized_official_last_name": "BLISSENBACH",
"authorized_official_first_name": "DAVID",
"authorized_official_middle_name": "ANTONE",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "618-274-2020",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in E St Louis, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.