RX Optical Laboratories, Inc

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901003762 Issued in MI

Legal business name

RX OPTICAL LABORATORIES, INC

Practice address

2000 E Beltline Ave NE
Grand Rapids, MI 49525-9716

Phone

(616) 608-0466

Fax

(616) 608-0467

NPI assigned

Sep 26, 2016

Organization subpart

No

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

Authorized official

Name

Stephan Jepson

Title

President

Phone

(269) 342-0003

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1474848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512950400000",
    "number": "1750830261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1825 S PARK ST",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490012779",
            "telephone_number": "269-342-0003",
            "fax_number": "269-342-4284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 E BELTLINE AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259716",
            "telephone_number": "616-608-0466",
            "fax_number": "616-608-0467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RX OPTICAL LABORATORIES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-26",
        "last_updated": "2017-12-11",
        "status": "A",
        "authorized_official_last_name": "JEPSON",
        "authorized_official_first_name": "STEPHAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "269-342-0003"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901003762",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1750830261",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samantha Rutkowski, OTRL
• April Rutledge
• Edward Rutowski
• Eric Ruvuna
• Michael Rux, BCBA
• RX Optical Laboratories, Inc.
• RX Optical Laboratories, Inc.
• RX Optical Laboratories, Inc.
• RX Optical Laboratories, Inc.
• RX Optical Laboratories, Inc.

• Optometrist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.