Provider Demographics
NPI:1851572200
Name:ALLEGANY OPTICAL LLC
Entity Type:Organization
Organization Name:ALLEGANY OPTICAL LLC
Other - Org Name:ALLEGANY OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:O.D. / MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:WHITELOCK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:717-263-2389
Mailing Address - Street 1:40 NOBLE BLVD
Mailing Address - Street 2:STE. 120
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-4122
Mailing Address - Country:US
Mailing Address - Phone:717-218-6656
Mailing Address - Fax:717-243-0738
Practice Address - Street 1:40 NOBLE BLVD
Practice Address - Street 2:STE. 120
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-4122
Practice Address - Country:US
Practice Address - Phone:717-218-6656
Practice Address - Fax:717-243-0738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6000006116152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007510100011Medicaid
PA1007510100010Medicaid
CJ5439OtherRAILROAD MEDICARE
PA1007510100010Medicaid
PA1007510100011Medicaid