Provider Demographics
NPI:1790797801
Name:OPTICAL NEI INC
Entity Type:Organization
Organization Name:OPTICAL NEI INC
Other - Org Name:TOWN AND COUNTY 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 1:2450 MEMORIAL HIGHWAY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612
Mailing Address - Country:US
Mailing Address - Phone:570-675-3627
Mailing Address - Fax:570-675-7320
Practice Address - Street 1:2450 MEMORIAL HIGHWAY
Practice Address - Street 2:SUITE 6
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612
Practice Address - Country:US
Practice Address - Phone:570-675-3627
Practice Address - Fax:570-675-7320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA296499OtherFEDERAL BS
51667OtherDAVIS
OP1837OtherEYEMED
PA05503OtherVBA
PA296499Other65 SPECIAL
PA18503OtherBS MICHIGAN
PA1018VENDOR24783OtherGEISINGER
26392OtherSPECTERA
PA287175Other65 SPECIAL
PA287175OtherFEDERAL BS
PA287175OtherBLUE SHIELD
51667OtherDAVIS
PA=========OtherFIRST PRIORITY
PA296499Other65 SPECIAL
PA=========OtherFIRST PRIORITY