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	296499	OTHER	PA	FEDERAL BS
2	51667	OTHER		DAVIS
3	OP1837	OTHER		EYEMED
4	PA05503	OTHER		VBA
5	296499	OTHER	PA	65 SPECIAL
6	PA18503	OTHER		BS MICHIGAN
7	1018VENDOR24783	OTHER	PA	GEISINGER
8	26392	OTHER		SPECTERA
9	287175	OTHER	PA	65 SPECIAL
10	287175	OTHER	PA	FEDERAL BS
11	287175	OTHER	PA	BLUE SHIELD

General Provider Information

NPI Number	:	1790797801
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTICAL NEI INC

Provider Business Mailing Address
First Line	:	2450 MEMORIAL HIGHWAY
Second Line	:	SUITE 6
City	:	DALLAS
State	:	PA
Zip	:	18612
Country	:	US
Telephone Number	:	570-675-3627
Fax Number	:	570-675-7320

Provider Business Practice Location Address
First Line	:	2450 MEMORIAL HIGHWAY
Second Line	:	SUITE 6
City	:	DALLAS
State	:	PA
Zip	:	18612
Country	:	US
Telephone Number	:	570-675-3627
Fax Number	:	570-675-7320

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	12/27/2017

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Directions to “OPTICAL NEI INC ” Practice Location

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