Provider Demographics
NPI:1376606426
Name:OPALKA, ROBERT GEORGE (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:GEORGE
Last Name:OPALKA
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 N 8TH ST
Mailing Address - Street 2:INDIANA OPTICAL
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-1701
Mailing Address - Country:US
Mailing Address - Phone:724-463-8131
Mailing Address - Fax:724-463-8131
Practice Address - Street 1:31 N 8TH ST
Practice Address - Street 2:INDIANA OPTICAL
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-1701
Practice Address - Country:US
Practice Address - Phone:724-463-8131
Practice Address - Fax:724-463-8131
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA218650OtherBLUE CROSS SHIELD
PA0742730001Medicare ID - Type Unspecified