MEDICARE: WAYNE OPTICAL CO

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	156F00000X	Technician/Technologist

General Provider Information

NPI Number	:	1801943287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAYNE OPTICAL CO

Provider Business Mailing Address
First Line	:	1417 N GEORGE ST
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17404-2014
Country	:	US
Telephone Number	:	717-846-6131
Fax Number	:	717-843-3937

Provider Business Practice Location Address
First Line	:	1417 N GEORGE ST
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17404-2014
Country	:	US
Telephone Number	:	717-846-6131
Fax Number	:	717-843-3937

Authorized Official
Title or Position	:	OWNER
Name	:	MR. SHANNON W ESTEP
Credential	:
Telephone Number	:	717-846-6131

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	08/22/2020

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Directions to “WAYNE OPTICAL CO ” Practice Location

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