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General NPI Number Information
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NPI Number | 1174787873
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Entity Type | Organization
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Legal Business Name | TRICE PROFESSIONAL OPTICAL
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Dates
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Enumeration Date | 07/11/2008
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Last Update Date | 08/07/2008
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Provider Practice Location Address
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Address Line | 35 N MAIN ST
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City | GREENSBURG
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State | PA
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Zip | 15601-2401
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Country | US
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Telephone | 724-836-2190
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Fax | 724-836-2127
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Provider Business Mailing Address
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Address Line | PO BOX 543 35 N MAIN STREET
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City | GREENSBURG
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State | PA
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Zip | 15601-0543
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Country | US
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Telephone | 724-836-2190
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Fax | 724-836-2127
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Authorized Official
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Title or Position | OWNER OPTICIAN
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Name | MR. KEVIN DWAINE BERGER
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Credential |
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Telephone | 724-836-2190
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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 | 6000001146
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License Number State | PA
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