1780653253 NPI number — RA OPTICAL

Table of content: (NPI 1780653253)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780653253 NPI number — RA OPTICAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RA 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:
RA OPTICAL/DALMO
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:
1780653253
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
214 CORBET ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TARENTUM
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15084-1815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-224-8806
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
214 CORBET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TARENTUM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15084-1815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-224-8806
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GROSSMAN
Authorized Official First Name:
MORRIS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
412-521-2100

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OEG000797 , 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: 396097 . This is a "NATIONAL VISION ADMIN." identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 44787 . This is a "DAVIS VISION" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 104915 . This is a "DORAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 160594 . This is a "COLE MANAGE VISION" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0775387 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 308997 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 14658 . This is a "SPECTERA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1646988 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 32663 . This is a "VISION BENEFITS OF AMER." identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 259931 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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