Provider Demographics
NPI:1134810567
Name:MAIN OPTICAL
Entity type:Organization
Organization Name:MAIN OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WARMOUTH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:570-283-0870
Mailing Address - Street 1:73 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LUZERNE
Mailing Address - State:PA
Mailing Address - Zip Code:18709-1201
Mailing Address - Country:US
Mailing Address - Phone:570-283-0870
Mailing Address - Fax:570-338-3500
Practice Address - Street 1:73 MAIN ST
Practice Address - Street 2:
Practice Address - City:LUZERNE
Practice Address - State:PA
Practice Address - Zip Code:18709-1201
Practice Address - Country:US
Practice Address - Phone:570-283-0870
Practice Address - Fax:570-338-3500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty