1902979347 NPI number — KALM OPTICAL II, INC.

Table of content: (NPI 1902979347)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902979347 NPI number — KALM OPTICAL II, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KALM OPTICAL II, 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:
PENNSYLVANIA VISION CENTER
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:
1902979347
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
564 UNION ST
Provider Second Line Business Mailing Address:
LUZERNE SHOPPING CENTER
Provider Business Mailing Address City Name:
LUZERNE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18709-1245
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-288-3336
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
564 UNION ST
Provider Second Line Business Practice Location Address:
LUZERNE SHOPPING CENTER
Provider Business Practice Location Address City Name:
LUZERNE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18709-1245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-288-3336
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SOLTYSIAK
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
570-288-3336

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OE-007231T , 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: 396879 . This is a "NATIONAL VISION ADMINISTO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 12445 . This is a "SPECTARA INSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 49775 . This is a "DAVIS INSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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