Healthcare Provider Details

I. General information

NPI: 1134810567
Provider Name (Legal Business Name): MAIN OPTICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 05/17/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 MAIN ST
LUZERNE PA
18709-1201
US

IV. Provider business mailing address

73 MAIN ST
LUZERNE PA
18709-1201
US

V. Phone/Fax

Practice location:
  • Phone: 570-283-0870
  • Fax: 570-338-3500
Mailing address:
  • Phone: 570-283-0870
  • Fax: 570-338-3500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: DR. TAMMY LYNN WARMOUTH
Title or Position: OPTOMETRIST
Credential: OD
Phone: 570-283-0870