Provider Demographics
NPI:1568630796
Name:ADOLPH OPTICAL SERVICE
Entity Type:Organization
Organization Name:ADOLPH OPTICAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:PROF
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRACATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-253-7977
Mailing Address - Street 1:687 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44303-1407
Mailing Address - Country:US
Mailing Address - Phone:330-253-7977
Mailing Address - Fax:
Practice Address - Street 1:687 W MARKET ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44303-1407
Practice Address - Country:US
Practice Address - Phone:330-253-7977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0417200001Medicare PIN
OH0417200001Medicare NSC