Healthcare Provider Details

I. General information

NPI: 1700183399
Provider Name (Legal Business Name): PERSONALTOURONLINE,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2011
Last Update Date: 01/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2495 ROUTE 6 SUITE 1
HAWLEY PA
18428-7005
US

IV. Provider business mailing address

2495 ROUTE 6
HAWLEY PA
18428-7005
US

V. Phone/Fax

Practice location:
  • Phone: 570-226-2400
  • Fax: 570-226-2401
Mailing address:
  • Phone: 570-226-2400
  • Fax: 570-226-2401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG002146
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberOEG002146
License Number StatePA

VIII. Authorized Official

Name: DR. JOHN JOSEPH GLASNER IV
Title or Position: OPTOMETRIST/OWNER
Credential: O.D.
Phone: 570-369-3139