Provider Demographics
NPI:1821104142
Name:OPTICAL NEI INC
Entity Type:Organization
Organization Name:OPTICAL NEI INC
Other - Org Name:
Other - Org Type:
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 1:304 W TIOGA ST
Practice Address - Street 2:
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657-6615
Practice Address - Country:US
Practice Address - Phone:570-836-2224
Practice Address - Fax:570-836-1125
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
PA287175OtherFEDERAL BS
PA296506OtherFEDERAL BS
PA1018VENDOR24783OtherGEISINGER
PA287175Other65 SPECIAL
PA296506Other65 SPECIAL
51619OtherDAVIS
PA18503OtherBS MICHIGAN
PA287175OtherBLUE SHIELD
PA54236OtherVBA
OP1837OtherEYEMED
26404OtherSPECTERA
PA1018VENDOR24783OtherGEISINGER
26404OtherSPECTERA
=========OtherVSP
PA077355021Medicare ID - Type Unspecified