Healthcare Provider Details

I. General information

NPI: 1407992761
Provider Name (Legal Business Name): VIP LOOK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 N MAIN AVE
SCRANTON PA
18504
US

IV. Provider business mailing address

455 N MAIN AVE
SCRANTON PA
18504
US

V. Phone/Fax

Practice location:
  • Phone: 570-346-5665
  • Fax: 570-346-5665
Mailing address:
  • Phone: 570-346-5665
  • Fax: 570-346-5665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number6000005683
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier393725
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerNVA
# 2
Identifier240221
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerBCBS

VIII. Authorized Official

Name: MS. HELEN REBECCA SMITH
Title or Position: PRESIDENT OPTICIAN
Credential:
Phone: 570-346-5665