1982710208 NPI number — OPTICAL NEI INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982710208 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:
TOWN & COUNTRY OPTICAL
Provider Other Organization Name Type Code:
4
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:
1982710208
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:
1582 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PECKVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18452-2029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-489-4430
Provider Business Practice Location Address Fax Number:
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: OP1837 . This is a "EYEMED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1018 . This is a "GEISINGER VENDOR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 24783 . This is a "GEISINGER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PA42360 . This is a "VBA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 296613 . This is a "FEDERAL BS" identifier , issued by the state of ( PA ) . 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: 296613 . This is a "65 SPECIAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 51617 . This is a "DAVIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 26399 . This is a "SPECTERA" identifier . 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: PA18503 . This is a "BS MICHIGAN" identifier . This identifiers is of the category "OTHER".




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