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General NPI Number Information
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NPI Number | 1629186861
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Entity Type | Organization
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Legal Business Name | G. S. OPTICAL, INC.
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Dates
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Enumeration Date | 08/28/2006
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Last Update Date | 03/02/2009
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Provider Practice Location Address
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Address Line | 7422 SOUTHERN BLVD
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City | YOUNGSTOWN
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State | OH
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Zip | 44512-5629
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Country | US
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Telephone | 330-758-3937
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Fax | 330-758-4956
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Provider Business Mailing Address
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Address Line | 7422 SOUTHERN BLVD
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City | YOUNGSTOWN
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State | OH
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Zip | 44512-5629
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Country | US
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Telephone | 330-758-3937
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Fax | 330-758-4956
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. GERALD S SEVACHKO
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Credential | M.D.
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Telephone | 330-758-3937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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