1700183399 NPI number — PERSONALTOURONLINE,INC.

Table of content: (NPI 1700183399)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700183399 NPI number — PERSONALTOURONLINE,INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERSONALTOURONLINE,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:
6
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:
1700183399
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2495 ROUTE 6
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAWLEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18428-7005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-226-2400
Provider Business Mailing Address Fax Number:
570-226-2401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2495 ROUTE 6
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
HAWLEY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18428-7005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-226-2400
Provider Business Practice Location Address Fax Number:
570-226-2401
Provider Enumeration Date:
02/17/2011

Additional Information

Authorized Official

Authorized Official Last Name:
GLASNER
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
OPTOMETRIST/OWNER
Authorized Official Telephone Number:
570-369-3139

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OEG002146 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332H00000X , with the licence number: OEG002146 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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