Provider Demographics
NPI:1073561981
Name:SCHEIB, GARY L
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:L
Last Name:SCHEIB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 420
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-0420
Mailing Address - Country:US
Mailing Address - Phone:570-622-3937
Mailing Address - Fax:
Practice Address - Street 1:307 MAHANTONGO ST
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3061
Practice Address - Country:US
Practice Address - Phone:570-622-3937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0EG001179152W00000X
PAOEG00179332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA391178OtherNATIONAL VISION ADM.
PA391221OtherNATIONAL VISION ADM.
PA391178OtherNATIONAL VISION ADM.
PAT29419Medicare UPIN
PA131682Medicare PIN
PA0427410001Medicare NSC