Provider Demographics
NPI:1790845667
Name:ANZELMI, FRANCIS R (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:FRANCIS
Middle Name:R
Last Name:ANZELMI
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OLD FORGE
Mailing Address - State:PA
Mailing Address - Zip Code:18518-1629
Mailing Address - Country:US
Mailing Address - Phone:570-457-7339
Mailing Address - Fax:570-451-0751
Practice Address - Street 1:437 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OLD FORGE
Practice Address - State:PA
Practice Address - Zip Code:18518-1629
Practice Address - Country:US
Practice Address - Phone:570-457-7339
Practice Address - Fax:570-451-0751
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1104560001Medicare NSC