Healthcare Provider Details

I. General information

NPI: 1962476259
Provider Name (Legal Business Name): CLASSIC OPTICAL LABORATORIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 BELMONT AVE
YOUNGSTOWN OH
44505-1406
US

IV. Provider business mailing address

3710 BELMONT AVE
YOUNGSTOWN OH
44505-1406
US

V. Phone/Fax

Practice location:
  • Phone: 330-759-8245
  • Fax: 330-759-8300
Mailing address:
  • Phone: 330-759-8245
  • Fax: 330-759-8300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FX1700X
TaxonomyOcularist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: RACHAEL ZBAN
Title or Position: PROJECT MANAGER
Credential:
Phone: 330-759-8245