Provider Demographics
NPI:1003061904
Name:COUNTY OPTICAL INC
Entity Type:Organization
Organization Name:COUNTY OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:ZAVADA
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:570-824-0039
Mailing Address - Street 1:1325 N RIVER ST
Mailing Address - Street 2:TUF-TEX PLAZA
Mailing Address - City:PLAINS
Mailing Address - State:PA
Mailing Address - Zip Code:18702-1838
Mailing Address - Country:US
Mailing Address - Phone:570-824-0039
Mailing Address - Fax:570-824-6922
Practice Address - Street 1:1325 N RIVER ST
Practice Address - Street 2:TUF-TEX PLAZA
Practice Address - City:PLAINS
Practice Address - State:PA
Practice Address - Zip Code:18702-1838
Practice Address - Country:US
Practice Address - Phone:570-824-0039
Practice Address - Fax:570-824-6922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier