CLASSIC OPTICAL LABORATORIES, INC.

Provider Demographics

• NPI: 1962476259
• Name: CLASSIC OPTICAL LABORATORIES, INC.
• Entity Type: Organization
• Organization Name: CLASSIC OPTICAL LABORATORIES, INC.
• Authorized Official - Title/Position: PROJECT MANAGER
• Authorized Official - First Name: RACHAEL
• Authorized Official - Last Name: ZBAN
• Authorized Official - Phone: 330-759-8245
• Mailing Address - Street 1: P.O. BOX 1341
• Mailing Address - Street 2: 3710 BELMONT AVE
• Mailing Address - City: YOUNGSTOWN
• Mailing Address - State: OH
• Mailing Address - Zip Code: 44501-1341
• Mailing Address - Country: US
• Mailing Address - Phone: 330-759-8245
• Mailing Address - Fax: 330-759-8300
• Practice Address - Street 1: 3710 BELMONT AVE
• Practice Address - City: YOUNGSTOWN
• Practice Address - State: OH
• Practice Address - Zip Code: 44505-1406
• Practice Address - Country: US
• Practice Address - Phone: 330-759-8245
• Practice Address - Fax: 330-759-8300
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-02-14
• Last Update Date: 2024-04-18

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	332H00000X	Suppliers	Eyewear Supplier
No	156FX1700X	Eye and Vision Services Providers	Technician/Technologist	Ocularist	Group - Multi-Specialty
No	156FX1800X	Eye and Vision Services Providers	Technician/Technologist	Optician	Group - Multi-Specialty
No	332B00000X	Suppliers	Durable Medical Equipment & Medical Supplies

Provider Identifiers

State	Identifier ID	ID Type	Issuer
MI	00AQ	Medicaid
FL	10796400	Medicaid
WI	38440000	Medicaid
AZ	514735	Medicaid
ME	METPID002653	Medicaid
KS	300003890260001	Medicaid
NH	3080114	Medicaid
CO	90000144065	Medicaid
OH	0001278	Medicaid
NE	10026655800	Medicaid
AL	0086601800	Medicaid
ID	IDTPID008181	Medicaid
IN	300004473	Medicaid
MD	333657300	Medicaid
NM	86934031	Medicaid
GA	003190959A	Medicaid
VT	1020469	Medicaid
AL	129503	Medicaid
LA	2559401	Medicaid
AR	TP025912	Medicaid