Provider Demographics
NPI:1578039574
Name:CPMOPTOMETRY LLC
Entity Type:Organization
Organization Name:CPMOPTOMETRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-895-4791
Mailing Address - Street 1:WALMART VISION
Mailing Address - Street 2:3271 ROUTE 940
Mailing Address - City:MT POCONO
Mailing Address - State:PA
Mailing Address - Zip Code:18344
Mailing Address - Country:US
Mailing Address - Phone:570-895-4791
Mailing Address - Fax:570-895-4793
Practice Address - Street 1:WALMART VISION
Practice Address - Street 2:3271 PA 940
Practice Address - City:MT POCONO
Practice Address - State:PA
Practice Address - Zip Code:17325
Practice Address - Country:US
Practice Address - Phone:570-895-4791
Practice Address - Fax:570-895-4793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-17
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY11729544OtherCAHQ