Provider Demographics
NPI:1598741175
Name:ENGLE EYEWEAR, INC.
Entity Type:Organization
Organization Name:ENGLE EYEWEAR, INC.
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:HFOAA
Authorized Official - Phone:570-208-1111
Mailing Address - Street 1:1100 HIGHWAY 315
Mailing Address - Street 2:PLAZA 315
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-6943
Mailing Address - Country:US
Mailing Address - Phone:570-208-1111
Mailing Address - Fax:570-270-4625
Practice Address - Street 1:1100 HIGHWAY 315
Practice Address - Street 2:PLAZA 315
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-6943
Practice Address - Country:US
Practice Address - Phone:570-208-1111
Practice Address - Fax:570-270-4625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact LensGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5630280001Medicare NSC