Healthcare Provider Details

I. General information

NPI: 1003961723
Provider Name (Legal Business Name): ICU2INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 08/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RTE 6 TRAP PLAZA
EYNON PA
18403
US

IV. Provider business mailing address

RTE 6 TRAP PLAZA
EYNON PA
18403
US

V. Phone/Fax

Practice location:
  • Phone: 570-876-5200
  • Fax: 570-876-5612
Mailing address:
  • Phone: 570-876-5200
  • Fax: 570-876-5612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MS. GINA M TANANA
Title or Position: OPTICIAN/TECH
Credential:
Phone: 570-876-5200