Healthcare Provider Details

I. General information

NPI: 1275649592
Provider Name (Legal Business Name): OPTICAL NEI INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 12/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MIFFLIN AVE
SCRANTON PA
18503
US

IV. Provider business mailing address

200 MIFFLIN AVE
SCRANTON PA
18503
US

V. Phone/Fax

Practice location:
  • Phone: 570-342-3145
  • Fax: 570-344-1309
Mailing address:
  • Phone: 570-342-3145
  • Fax: 570-344-1309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier287175
Identifier TypeOTHER
Identifier StatePA
Identifier Issuer65 SPECIAL
# 2
Identifier287175
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerFEDERAL BS
# 3
IdentifierOP1837
Identifier TypeOTHER
Identifier State
Identifier IssuerEYEMED
# 4
IdentifierPA94236
Identifier TypeOTHER
Identifier State
Identifier IssuerVBA
# 5
Identifier1018VENDOR24783
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerGEISINGER
# 6
Identifier26397
Identifier TypeOTHER
Identifier State
Identifier IssuerSPECTERA
# 7
Identifier231971
Identifier TypeOTHER
Identifier StatePA
Identifier Issuer65 SPECIAL
# 8
Identifier51613
Identifier TypeOTHER
Identifier State
Identifier IssuerDAVIS
# 9
Identifier287175
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerBLUE SHIELD
# 10
Identifier231971
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerFEDERAL BS
# 11
IdentifierPA18503
Identifier TypeOTHER
Identifier State
Identifier IssuerBS MICHIGAN

VIII. Authorized Official

Name: JOSEPH J CARROLL
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 570-342-3145