Provider Demographics
NPI:1730197799
Name:ACTON OPTICAL, LLC
Entity type:Organization
Organization Name:ACTON OPTICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN-CERTIFIED
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BETSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-233-5246
Mailing Address - Street 1:3628 KIMBALL AVE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5731
Mailing Address - Country:US
Mailing Address - Phone:319-233-5246
Mailing Address - Fax:319-833-8197
Practice Address - Street 1:3628 KIMBALL AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5731
Practice Address - Country:US
Practice Address - Phone:319-233-5246
Practice Address - Fax:319-833-8197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0149138Medicaid
IA0149138Medicaid