MEDICARE: COUNTY OPTICAL INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1003061904
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OPTICAL INC

Provider Business Mailing Address
First Line	:	1325 N RIVER ST
Second Line	:	TUF-TEX PLAZA
City	:	PLAINS
State	:	PA
Zip	:	18702-1838
Country	:	US
Telephone Number	:	570-824-0039
Fax Number	:	570-824-6922

Provider Business Practice Location Address
First Line	:	1325 N RIVER ST
Second Line	:	TUF-TEX PLAZA
City	:	PLAINS
State	:	PA
Zip	:	18702-1838
Country	:	US
Telephone Number	:	570-824-0039
Fax Number	:	570-824-6922

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JOHN LOUIS ZAVADA
Credential	:	OPTICIAN
Telephone Number	:	570-824-0039

Provider Enumeration Date	:	11/20/2008
Last Update Date	:	11/20/2008

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Directions to “COUNTY OPTICAL INC ” Practice Location

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