Provider Demographics
NPI:1548598568
Name:ENGLE EYEWEAR OPTICAL LLC
Entity Type:Organization
Organization Name:ENGLE EYEWEAR OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-208-1111
Mailing Address - Street 1:1100 HIGHWAY 315 BLVD
Mailing Address - Street 2:PLAZA 315
Mailing Address - City:PLAINS
Mailing Address - State:PA
Mailing Address - Zip Code:18702-6943
Mailing Address - Country:US
Mailing Address - Phone:570-208-1111
Mailing Address - Fax:
Practice Address - Street 1:1100 HIGHWAY 315 BLVD
Practice Address - Street 2:PLAZA 315
Practice Address - City:PLAINS
Practice Address - State:PA
Practice Address - Zip Code:18702-6943
Practice Address - Country:US
Practice Address - Phone:570-208-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier