Provider Demographics
NPI:1700183399
Name:PERSONALTOURONLINE,INC.
Entity type:Organization
Organization Name:PERSONALTOURONLINE,INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GLASNER
Authorized Official - Suffix:IV
Authorized Official - Credentials:OD
Authorized Official - Phone:570-369-3139
Mailing Address - Street 1:2495 ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:HAWLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18428-7005
Mailing Address - Country:US
Mailing Address - Phone:570-226-2400
Mailing Address - Fax:570-226-2401
Practice Address - Street 1:2495 ROUTE 6
Practice Address - Street 2:SUITE 1
Practice Address - City:HAWLEY
Practice Address - State:PA
Practice Address - Zip Code:18428-7005
Practice Address - Country:US
Practice Address - Phone:570-226-2400
Practice Address - Fax:570-226-2401
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERSONALTOURONLINE,INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-17
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002146332H00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA259388Medicare PIN