Provider Demographics
NPI:1073790549
Name:RANDALL C MENGEL,OD
Entity Type:Organization
Organization Name:RANDALL C MENGEL,OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:J
Authorized Official - Last Name:MENGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-562-5005
Mailing Address - Street 1:14 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:PA
Mailing Address - Zip Code:19526-1508
Mailing Address - Country:US
Mailing Address - Phone:610-562-5005
Mailing Address - Fax:610-562-5005
Practice Address - Street 1:14 N 4TH ST
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:PA
Practice Address - Zip Code:19526-1508
Practice Address - Country:US
Practice Address - Phone:610-562-5005
Practice Address - Fax:610-562-5005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001544332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0594870001Medicare NSC