Provider Demographics
NPI:1497873269
Name:SANATOGA OPTICAL
Entity Type:Organization
Organization Name:SANATOGA OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSTAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-326-5448
Mailing Address - Street 1:1560 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-3225
Mailing Address - Country:US
Mailing Address - Phone:610-326-5448
Mailing Address - Fax:
Practice Address - Street 1:1560 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-3225
Practice Address - Country:US
Practice Address - Phone:610-326-5448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANATOGA OPHTHALMOLOGY ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-27
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0187850001Medicare NSC