1922281658 NPI number — ROSS-MCDONNELL OPTICAL

Table of content: (NPI 1922281658)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922281658 NPI number — ROSS-MCDONNELL OPTICAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROSS-MCDONNELL 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:
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:
1922281658
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
217 E DRINKER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUNMORE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18512-2589
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-348-0464
Provider Business Mailing Address Fax Number:
570-343-7049

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
217 E DRINKER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUNMORE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18512-2589
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-348-0464
Provider Business Practice Location Address Fax Number:
570-343-7049
Provider Enumeration Date:
12/17/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ROSS
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER/OPTICIAN
Authorized Official Telephone Number:
570-348-0464

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200383 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 393311 . This is a "NVA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".