Provider Demographics
NPI:1164572368
Name:OLEAN OPTICAL LAB
Entity Type:Organization
Organization Name:OLEAN OPTICAL LAB
Other - Org Name:MORGAN OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:OPT
Authorized Official - Phone:814-368-4747
Mailing Address - Street 1:8 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-2014
Mailing Address - Country:US
Mailing Address - Phone:814-368-4747
Mailing Address - Fax:814-368-4797
Practice Address - Street 1:8 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-2014
Practice Address - Country:US
Practice Address - Phone:814-368-4747
Practice Address - Fax:814-368-4797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies