Provider Demographics
NPI:1669659041
Name:ALLEGANY OPTICAL LLC
Entity Type:Organization
Organization Name:ALLEGANY OPTICAL LLC
Other - Org Name:ALLEGANY OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:O.D. / MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:WHITELOCK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:717-263-2389
Mailing Address - Street 1:125 S ANTRIM WAY
Mailing Address - Street 2:
Mailing Address - City:GREENCASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:17225-1521
Mailing Address - Country:US
Mailing Address - Phone:717-597-4780
Mailing Address - Fax:717-597-4755
Practice Address - Street 1:125 S ANTRIM WAY
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:PA
Practice Address - Zip Code:17225-1521
Practice Address - Country:US
Practice Address - Phone:717-597-4780
Practice Address - Fax:717-597-4755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA80955344152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1252160013Medicare NSC
PA051270Medicare PIN