Provider Demographics
NPI:1346489465
Name:OMEGA OPTICAL, INC.
Entity Type:Organization
Organization Name:OMEGA OPTICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-885-1200
Mailing Address - Street 1:2385 W CHELTENHAM AVE
Mailing Address - Street 2:STE 336
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19150-1506
Mailing Address - Country:US
Mailing Address - Phone:215-885-1200
Mailing Address - Fax:215-885-8807
Practice Address - Street 1:2385 W CHELTENHAM AVE
Practice Address - Street 2:STE 336
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19150-1506
Practice Address - Country:US
Practice Address - Phone:215-885-1200
Practice Address - Fax:215-885-8807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty