1568643815 NPI number — ALLEGANY OPTICAL LLC

Table of content: (NPI 1568643815)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568643815 NPI number — ALLEGANY OPTICAL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLEGANY OPTICAL LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ALLEGANY OPTICAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568643815
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1039 WAYNE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHAMBERSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17201-2923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-263-2389
Provider Business Mailing Address Fax Number:
717-263-0884

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1039 WAYNE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHAMBERSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17201-2923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-263-2389
Provider Business Practice Location Address Fax Number:
717-263-0884
Provider Enumeration Date:
11/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WHITELOCK
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
J
Authorized Official Title or Position:
O.D. / MANAGING MEMBER
Authorized Official Telephone Number:
717-263-2389

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1007510100010 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007510100005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CJ5439 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com