Provider Demographics
NPI:1790891018
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 1:10 1/2 S MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN TOP
Practice Address - State:PA
Practice Address - Zip Code:18707-1123
Practice Address - Country:US
Practice Address - Phone:570-403-1341
Practice Address - Fax:570-403-3062
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
PA287175Other65 SPECIAL
PA287175OtherBLUE SHIELD
OP1837OtherEYEMED
PA42362OtherVBA
PA24783OtherGEISINGER
PA287175OtherFEDERAL BS
26398OtherSPECTERA
PA296499OtherFEDERAL BS
PA18503OtherBS MICHIGAN
PA1018OtherGEISINGER VENDOR
PA296499Other65 SPECIAL
51655OtherDAVIS
PA296499Other65 SPECIAL
PA=========OtherFIRST PRIORITY
51655OtherDAVIS
=========OtherVSP