Provider Demographics
NPI:1780653253
Name:RA OPTICAL
Entity Type:Organization
Organization Name:RA OPTICAL
Other - Org Name:RA OPTICAL/DALMO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MORRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-521-2100
Mailing Address - Street 1:214 CORBET ST
Mailing Address - Street 2:
Mailing Address - City:TARENTUM
Mailing Address - State:PA
Mailing Address - Zip Code:15084-1815
Mailing Address - Country:US
Mailing Address - Phone:724-224-8806
Mailing Address - Fax:
Practice Address - Street 1:214 CORBET ST
Practice Address - Street 2:
Practice Address - City:TARENTUM
Practice Address - State:PA
Practice Address - Zip Code:15084-1815
Practice Address - Country:US
Practice Address - Phone:724-224-8806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000797152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA396097OtherNATIONAL VISION ADMIN.
PA44787OtherDAVIS VISION
PA104915OtherDORAL
PA160594OtherCOLE MANAGE VISION
PA0775387Medicaid
PA308997OtherUPMC
PA14658OtherSPECTERA
PA1646988OtherBLUE SHIELD
PA32663OtherVISION BENEFITS OF AMER.
PA259931OtherHEALTH AMERICA
PA396097OtherNATIONAL VISION ADMIN.
PA160594OtherCOLE MANAGE VISION