Provider Demographics
NPI:1528038593
Name:OPTICAL WORLD 257 INC.
Entity Type:Organization
Organization Name:OPTICAL WORLD 257 INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:FLINCHBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-677-7048
Mailing Address - Street 1:3108 STATE ROUTE 257
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:PA
Mailing Address - Zip Code:16346-2426
Mailing Address - Country:US
Mailing Address - Phone:814-677-7048
Mailing Address - Fax:
Practice Address - Street 1:3108 STATE ROUTE 257
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:PA
Practice Address - Zip Code:16346-2426
Practice Address - Country:US
Practice Address - Phone:814-677-7048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6000000094332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009506560002OtherPA STATE MEDICAL ASSISTAN
PA0009506560002OtherPA STATE MEDICAL ASSISTAN