1710093034 NPI number — OPTICAL NEI INC

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710093034 NPI number — OPTICAL NEI INC

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 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:

1710093034

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

12/27/2017

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

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 First Line Business Practice Location Address:

16749 STATE ROUTE 706

Provider Second Line Business Practice Location Address:

SUITE 4

Provider Business Practice Location Address City Name:

MONTROSE

Provider Business Practice Location Address State Name:

PA

Provider Business Practice Location Address Postal Code:

18801-6502

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

570-278-2279

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

08/21/2006

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

• Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• 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".
• Identifier: PA42361 . This is a "VBA" identifier . This identifiers is of the category "OTHER".
• Identifier: 287175 . This is a "FEDERAL BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 296499 . This is a "FEDERAL BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 26391 . This is a "SPECTERA" identifier . 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: 287175 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . 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: 296499 . This is a "65 SPECIAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 51672 . This is a "DAVIS" identifier . This identifiers is of the category "OTHER".
• Identifier: OP1837 . This is a "EYEMED" identifier . This identifiers is of the category "OTHER".