Provider Demographics
NPI:1851492763
Name:DEL OPTICIANS, LLC
Entity Type:Organization
Organization Name:DEL OPTICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:PETRYKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:740-344-4747
Mailing Address - Street 1:1494 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1825
Mailing Address - Country:US
Mailing Address - Phone:740-927-8152
Mailing Address - Fax:
Practice Address - Street 1:1494 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1825
Practice Address - Country:US
Practice Address - Phone:740-927-8152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2009-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4222332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0934958Medicaid
OH0934958Medicaid
OH=========027OtherCARESOURCE
OH5794690001Medicare NSC