1598741175 NPI number — ENGLE EYEWEAR, INC.

Table of content: JOHN JAMES MCGLYNN III MD (NPI 1508327529)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598741175 NPI number — ENGLE EYEWEAR, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENGLE EYEWEAR, 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:
1598741175
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 HIGHWAY 315
Provider Second Line Business Mailing Address:
PLAZA 315
Provider Business Mailing Address City Name:
WILKES BARRE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18702-6943
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-208-1111
Provider Business Mailing Address Fax Number:
570-270-4625

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 HIGHWAY 315
Provider Second Line Business Practice Location Address:
PLAZA 315
Provider Business Practice Location Address City Name:
WILKES BARRE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18702-6943
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-208-1111
Provider Business Practice Location Address Fax Number:
570-270-4625
Provider Enumeration Date:
12/15/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ENGLE
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
570-208-1111

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 156FC0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 156FX1800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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