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General NPI Number Information
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NPI Number | 1710545868
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Entity Type | Organization
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Legal Business Name | MYOPTIK
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Dates
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Enumeration Date | 06/04/2019
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Last Update Date | 06/21/2019
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Provider Practice Location Address
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Address Line | 102 QUAIL LN STE 2
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City | MIFFLINBURG
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State | PA
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Zip | 17844-9325
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Country | US
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Telephone | 570-966-0101
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Fax |
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Provider Business Mailing Address
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Address Line | 102 QUAIL LN STE 2
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City | MIFFLINBURG
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State | PA
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Zip | 17844-9325
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Country | US
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Telephone | 570-966-0101
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Fax |
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Authorized Official
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Title or Position | BILLING SPECIALIST
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Name | BOBBIE BOTTS
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Credential |
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Telephone | 570-217-7171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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