Provider Demographics
NPI:1205899077
Name:ADVENTURE OPTICAL INC.
Entity type:Organization
Organization Name:ADVENTURE OPTICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:G
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-533-4499
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:STEWARTVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55976-0036
Mailing Address - Country:US
Mailing Address - Phone:507-533-4499
Mailing Address - Fax:507-533-4424
Practice Address - Street 1:1901 1ST AVE NE
Practice Address - Street 2:
Practice Address - City:STEWARTVILLE
Practice Address - State:MN
Practice Address - Zip Code:55976-9318
Practice Address - Country:US
Practice Address - Phone:507-533-4499
Practice Address - Fax:507-533-4424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty