MEDICARE: OPTICAL NEI 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	26402	OTHER		SPECTERA
2	296504	OTHER	PA	FEDERAL BS
3	OP1837	OTHER		EYEMED
4	1018	OTHER	PA	GEISINGER
5	24783	OTHER	PA	GEISINGER VENDOR
6	287175	OTHER	PA	BLUE SHIELD
7	296504	OTHER	PA	65 SPECIAL
8	PA18503	OTHER		BS MICHIGAN
9	PA74236	OTHER		VBA
10	287175	OTHER	PA	65 SPECIAL
11	51669	OTHER		DAVIS
12	287178	OTHER	PA	FEDERAL BS

General Provider Information

NPI Number	:	1558477877
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTICAL NEI INC

Provider Business Mailing Address
First Line	:	200 MIFFLIN AVE
Second Line	:
City	:	SCRANTON
State	:	PA
Zip	:	18503-1982
Country	:	US
Telephone Number	:	570-342-3145
Fax Number	:	570-344-1309

Provider Business Practice Location Address
First Line	:	626 PARK ST
Second Line	:
City	:	HONESDALE
State	:	PA
Zip	:	18431-1446
Country	:	US
Telephone Number	:	570-253-1720
Fax Number	:

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	JOSEPH J CARROLL
Credential	:
Telephone Number	:	570-342-3145

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	12/27/2017

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Directions to “OPTICAL NEI INC ” Practice Location

Language	Start Address	Practice Location

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