Provider Demographics
NPI:1326223157
Name:MICHAEL F. NOVOTNY
Entity Type:Organization
Organization Name:MICHAEL F. NOVOTNY
Other - Org Name:MARANATHA OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLERICAL
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-834-1308
Mailing Address - Street 1:949 S SAINT MARYS ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857-2830
Mailing Address - Country:US
Mailing Address - Phone:814-834-1308
Mailing Address - Fax:814-834-1406
Practice Address - Street 1:949 S SAINT MARYS ST
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-2830
Practice Address - Country:US
Practice Address - Phone:814-834-1308
Practice Address - Fax:814-834-1406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0243250001Medicare NSC