Healthcare Provider Details

I. General information

NPI: 1396927133
Provider Name (Legal Business Name): THE OPTICAL HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 WYOMING AVE
SCRANTON PA
18509-2803
US

IV. Provider business mailing address

1360 WYOMING AVE
SCRANTON PA
18509-2803
US

V. Phone/Fax

Practice location:
  • Phone: 570-348-0822
  • Fax: 570-348-0823
Mailing address:
  • Phone: 570-348-0822
  • Fax: 570-348-0823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BERNARD VANISKY
Title or Position: OWNER
Credential: OPTICIAN
Phone: 570-348-0822