Provider Demographics
NPI:1053537506
Name:CRYSTAL OPTICAL
Entity type:Organization
Organization Name:CRYSTAL OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMET
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:915-751-7747
Mailing Address - Street 1:9861 DYER ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79924-4769
Mailing Address - Country:US
Mailing Address - Phone:915-751-7747
Mailing Address - Fax:915-751-9799
Practice Address - Street 1:9861 DYER ST
Practice Address - Street 2:SUITE 3
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-4769
Practice Address - Country:US
Practice Address - Phone:915-751-7747
Practice Address - Fax:915-751-9799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNOT REQUIRED332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier