Provider Demographics
NPI:1629186861
Name:G. S. OPTICAL, INC.
Entity Type:Organization
Organization Name:G. S. OPTICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:S
Authorized Official - Last Name:SEVACHKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-758-3937
Mailing Address - Street 1:7422 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5629
Mailing Address - Country:US
Mailing Address - Phone:330-758-3937
Mailing Address - Fax:330-758-4956
Practice Address - Street 1:7422 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-5629
Practice Address - Country:US
Practice Address - Phone:330-758-3937
Practice Address - Fax:330-758-4956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0492490001Medicare NSC