Provider Demographics
NPI:1306000625
Name:GAHRING OPTICAL
Entity Type:Organization
Organization Name:GAHRING OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BAILEY
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-726-4924
Mailing Address - Street 1:200 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-2353
Mailing Address - Country:US
Mailing Address - Phone:814-726-4924
Mailing Address - Fax:814-726-2955
Practice Address - Street 1:200 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-2353
Practice Address - Country:US
Practice Address - Phone:814-726-4924
Practice Address - Fax:814-726-2955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5646200001Medicare NSC