1700977758 NPI number — R A OPTICAL

Table of content: (NPI 1700977758)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700977758 NPI number — R A OPTICAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
R A OPTICAL
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:
DALMO 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:
1700977758
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
330 N MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUTLER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16001-4954
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-282-8533
Provider Business Mailing Address Fax Number:
724-282-9735

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUTLER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16001-4954
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-282-8533
Provider Business Practice Location Address Fax Number:
724-282-9735
Provider Enumeration Date:
09/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CARRABBA
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
J
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
724-282-8533

Provider Taxonomy Codes

  • Taxonomy code: 156FX1800X , with the licence number:  6000001101 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 160592 . This is a "COLE VISION LOCATION #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PA42663 . This is a "VBA PROVIDER #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1634738 . This is a "HIGHMARK PROVIDER NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 105365 . This is a "DORAL LOCATION NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com