Provider Demographics
NPI:1053536227
Name:CYPRESS OPTICAL, INC
Entity type:Organization
Organization Name:CYPRESS OPTICAL, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO & SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:RUDOLPH
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARVER
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC
Authorized Official - Phone:530-245-4477
Mailing Address - Street 1:555 E CYPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-0105
Mailing Address - Country:US
Mailing Address - Phone:530-722-9992
Mailing Address - Fax:530-722-9997
Practice Address - Street 1:555 E CYPRESS AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0105
Practice Address - Country:US
Practice Address - Phone:530-722-9992
Practice Address - Fax:530-722-9997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD 7026156FX1800X
CASL5079156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty