Provider Demographics
NPI:1710093034
Name:OPTICAL NEI INC
Entity Type:Organization
Organization Name:OPTICAL NEI INC
Other - Org Name:TOWN & COUNTRY OPTICAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-342-3145
Mailing Address - Street 1:200 MIFFLIN AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-1982
Mailing Address - Country:US
Mailing Address - Phone:570-342-3145
Mailing Address - Fax:570-344-1309
Practice Address - Street 1:16749 STATE ROUTE 706
Practice Address - Street 2:SUITE 4
Practice Address - City:MONTROSE
Practice Address - State:PA
Practice Address - Zip Code:18801-6502
Practice Address - Country:US
Practice Address - Phone:570-278-2279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA287175Other65 SPECIAL
PA18503OtherBS MICHIGAN
PA42361OtherVBA
PA287175OtherFEDERAL BS
PA296499OtherFEDERAL BS
26391OtherSPECTERA
PA24783OtherGEISINGER
PA287175OtherBLUE SHIELD
PA1018OtherGEISINGER VENDOR
PA296499Other65 SPECIAL
51672OtherDAVIS
OP1837OtherEYEMED
PA296499Other65 SPECIAL
PA42361OtherVBA
PA287175Other65 SPECIAL
PA=========OtherFIRST PRIORITY