Provider Demographics
NPI:1396927133
Name:THE OPTICAL HOUSE
Entity type:Organization
Organization Name:THE OPTICAL HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:VANISKY
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:570-348-0822
Mailing Address - Street 1:1360 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18509-2803
Mailing Address - Country:US
Mailing Address - Phone:570-348-0822
Mailing Address - Fax:570-348-0823
Practice Address - Street 1:1360 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18509-2803
Practice Address - Country:US
Practice Address - Phone:570-348-0822
Practice Address - Fax:570-348-0823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0620270001Medicare NSC