Provider Demographics
NPI:1285838607
Name:LUZERNE OPTICAL LABORATORIES, LTD.
Entity Type:Organization
Organization Name:LUZERNE OPTICAL LABORATORIES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:DOUGHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-822-3183
Mailing Address - Street 1:180 N WILKES BARRE BLVD
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-5341
Mailing Address - Country:US
Mailing Address - Phone:570-822-3183
Mailing Address - Fax:570-821-7518
Practice Address - Street 1:180 N WILKES BARRE BLVD
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-5341
Practice Address - Country:US
Practice Address - Phone:570-822-3183
Practice Address - Fax:570-821-7518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier