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General NPI Number Information
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NPI Number | 1144910258
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Entity Type | Individual
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Provider Name | PELU TORRES OPTICIAN
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Gender | Male
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Dates
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Enumeration Date | 05/11/2023
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Last Update Date | 05/11/2023
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Provider Practice Location Address
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Address Line | 355 LINCOLN AVE
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301-2814
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Country | US
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Telephone | 570-424-8728
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Fax | 570-424-8751
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Provider Business Mailing Address
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Address Line | 4411 CIRCLE DR
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City | BETHLEHEM
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State | PA
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Zip | 18020-9607
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Country | US
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Telephone | 484-554-5252
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Fax | 570-424-8751
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 150945
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License Number State | PA
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