Healthcare Provider Details

I. General information

NPI: 1154347813
Provider Name (Legal Business Name): CENTRE OPTICAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 01/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 LOCUST LN
STATE COLLEGE PA
16801-5419
US

IV. Provider business mailing address

507 LOCUST LN
STATE COLLEGE PA
16801-5419
US

V. Phone/Fax

Practice location:
  • Phone: 814-238-5392
  • Fax: 814-237-5663
Mailing address:
  • Phone: 814-238-5392
  • Fax: 814-237-5663

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: MS. EVELYN POPE
Title or Position: OFFICE MANAGER
Credential:
Phone: 814-238-5392