Healthcare Provider Details

I. General information

NPI: 1477524536
Provider Name (Legal Business Name): OPTICAL WORLD 257 INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 S FRANKLIN ST
TITUSVILLE PA
16354-1738
US

IV. Provider business mailing address

PO BOX 516
TITUSVILLE PA
16354-0516
US

V. Phone/Fax

Practice location:
  • Phone: 814-677-7048
  • Fax:
Mailing address:
  • Phone: 814-827-9481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number6000002045
License Number StatePA

VIII. Authorized Official

Name: MR. JAMES FLINCHBAUGH
Title or Position: PRESIDENT
Credential:
Phone: 814-677-7048