Provider Demographics
NPI:1396076436
Name:MISKE EYE CARE OPTICAL INC
Entity type:Organization
Organization Name:MISKE EYE CARE OPTICAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES/OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MISKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-462-2254
Mailing Address - Street 1:117 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:PA
Mailing Address - Zip Code:17976-2337
Mailing Address - Country:US
Mailing Address - Phone:570-462-2254
Mailing Address - Fax:570-462-2264
Practice Address - Street 1:117 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:PA
Practice Address - Zip Code:17976-2337
Practice Address - Country:US
Practice Address - Phone:570-462-2254
Practice Address - Fax:570-462-2264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier