Provider Demographics
NPI:1184877318
Name:CONTACT FILL, LLC
Entity type:Organization
Organization Name:CONTACT FILL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NICOLETOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-574-2400
Mailing Address - Street 1:5040 RITTER RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-4879
Mailing Address - Country:US
Mailing Address - Phone:717-458-9116
Mailing Address - Fax:
Practice Address - Street 1:5040 RITTER RD
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-4879
Practice Address - Country:US
Practice Address - Phone:717-458-9116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATIONAL VISION ADMINISTRATORS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAN/A332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier