1821104142 NPI number — OPTICAL NEI INC

Table of content: (NPI 1821104142)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821104142 NPI number — OPTICAL NEI INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPTICAL NEI INC
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:
Provider Other Organization Name Type Code:
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:
1821104142
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 MIFFLIN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCRANTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18503-1982
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-342-3145
Provider Business Mailing Address Fax Number:
570-344-1309

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
304 W TIOGA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUNKHANNOCK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18657-6615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-836-2224
Provider Business Practice Location Address Fax Number:
570-836-1125
Provider Enumeration Date:
08/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CARROLL
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
570-342-3145

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 287175 . This is a "FEDERAL BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 296506 . This is a "FEDERAL BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1018VENDOR24783 . This is a "GEISINGER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 287175 . This is a "65 SPECIAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 296506 . This is a "65 SPECIAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 51619 . This is a "DAVIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: PA18503 . This is a "BS MICHIGAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 287175 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PA54236 . This is a "VBA" identifier . This identifiers is of the category "OTHER".
  • Identifier: OP1837 . This is a "EYEMED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 26404 . This is a "SPECTERA" identifier . This identifiers is of the category "OTHER".




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