Provider Demographics
NPI:1205944139
Name:STANLEY R NEBEL OD INC
Entity type:Organization
Organization Name:STANLEY R NEBEL OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:NEBEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:814-432-5121
Mailing Address - Street 1:PO BOX 750
Mailing Address - Street 2:1402 LIBERTY STREET
Mailing Address - City:FRANKLIN
Mailing Address - State:PA
Mailing Address - Zip Code:16323
Mailing Address - Country:US
Mailing Address - Phone:814-432-5121
Mailing Address - Fax:814-432-5121
Practice Address - Street 1:1402 LIBERTY STREET
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:PA
Practice Address - Zip Code:16323
Practice Address - Country:US
Practice Address - Phone:814-432-5121
Practice Address - Fax:814-432-5121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0EG001064152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5674990001Medicare NSC