Provider Demographics
NPI:1346414828
Name:PLYMOUTH OPTICIANS
Entity Type:Organization
Organization Name:PLYMOUTH OPTICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:J
Authorized Official - Last Name:TORELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-279-8247
Mailing Address - Street 1:1019 GERMANTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-2449
Mailing Address - Country:US
Mailing Address - Phone:610-279-8247
Mailing Address - Fax:610-279-8249
Practice Address - Street 1:1019 GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-2449
Practice Address - Country:US
Practice Address - Phone:610-279-8247
Practice Address - Fax:610-279-8249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0155830001Medicare NSC