Provider Demographics
NPI:1538326194
Name:PROFESSIONAL OPTICIANS
Entity Type:Organization
Organization Name:PROFESSIONAL OPTICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:VANDEUREN-HOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC
Authorized Official - Phone:717-667-6023
Mailing Address - Street 1:PO BOX 512
Mailing Address - Street 2:4704 OLD US HWY 322
Mailing Address - City:REEDSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17084-0512
Mailing Address - Country:US
Mailing Address - Phone:717-667-6023
Mailing Address - Fax:717-667-9597
Practice Address - Street 1:4704 OLD US HWY 322
Practice Address - Street 2:
Practice Address - City:REEDSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17084-0512
Practice Address - Country:US
Practice Address - Phone:717-667-6023
Practice Address - Fax:717-667-9597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0914930001Medicare PIN