Provider Demographics
NPI:1730295056
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 1:150 BROOKLYN ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:PA
Practice Address - Zip Code:18407-2274
Practice Address - Country:US
Practice Address - Phone:570-282-7188
Practice Address - Fax:570-282-4402
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
26395OtherSPECTERA
PA287175Other65 SPECIAL
51663OtherDAVIS
OP1837OtherEYEMED
PA24783OtherGEISINGER VENDOR
PA287175OtherBLUE SHIELD
PA287175OtherFEDERAL BS
PA296609OtherFEDERAL BS
PA34236OtherVBA
PA0773550016Medicaid
PA1018OtherGEISINGER
PA296609Other65 SPECIAL
PA18503OtherBS MICHIGAN
=========OtherVSP
PA0773550016Medicaid
PA287175OtherFEDERAL BS