Provider Demographics
NPI:1558392639
Name:GARUNGA INC
Entity Type:Organization
Organization Name:GARUNGA INC
Other - Org Name:CRYSTAL VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GROMELSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-675-8888
Mailing Address - Street 1:65 COUNTRY CLUB SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-1235
Mailing Address - Country:US
Mailing Address - Phone:570-675-8888
Mailing Address - Fax:570-675-8375
Practice Address - Street 1:65 COUNTRY CLUB SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-1235
Practice Address - Country:US
Practice Address - Phone:570-675-8888
Practice Address - Fax:570-675-8375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE0004159P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1230760001Medicare NSC