Provider Demographics
NPI:1770651374
Name:CENTRAL CITY OPTICAL COMPANY
Entity Type:Organization
Organization Name:CENTRAL CITY OPTICAL COMPANY
Other - Org Name:PHILADELPHIA EYEGLASS LABS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:MESSINGER
Authorized Official - Last Name:MESHKOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-592-8111
Mailing Address - Street 1:1030 ARCH ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3011
Mailing Address - Country:US
Mailing Address - Phone:215-592-8111
Mailing Address - Fax:215-592-0758
Practice Address - Street 1:1030 ARCH ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-3011
Practice Address - Country:US
Practice Address - Phone:215-592-8111
Practice Address - Fax:215-592-0758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE6131T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty