Provider Demographics
NPI:1184168148
Name:L&M OPTICAL INC
Entity type:Organization
Organization Name:L&M OPTICAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:PERER
Authorized Official - Last Name:DROZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-421-9274
Mailing Address - Street 1:4048 BEECHWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-2618
Mailing Address - Country:US
Mailing Address - Phone:412-421-9274
Mailing Address - Fax:412-421-6308
Practice Address - Street 1:4048 BEECHWOOD BLVD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-2618
Practice Address - Country:US
Practice Address - Phone:412-421-9274
Practice Address - Fax:412-421-6308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-10
Last Update Date:2016-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1556FC0801X156FC0801X
PA156FX1800X156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPA06128OtherVISION BENEFITS OF AMERICA