Healthcare Provider Details

I. General information

NPI: 1538326194
Provider Name (Legal Business Name): PROFESSIONAL OPTICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 05/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4704 OLD US HWY 322
REEDSVILLE PA
17084-0512
US

IV. Provider business mailing address

PO BOX 512 4704 OLD US HWY 322
REEDSVILLE PA
17084-0512
US

V. Phone/Fax

Practice location:
  • Phone: 717-667-6023
  • Fax: 717-667-9597
Mailing address:
  • Phone: 717-667-6023
  • Fax: 717-667-9597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: SUSAN B VANDEUREN-HOBBS
Title or Position: OWNER/OPTICIAN
Credential: ABOC
Phone: 717-667-6023