Provider Demographics
NPI:1700977758
Name:R A OPTICAL
Entity Type:Organization
Organization Name:R A OPTICAL
Other - Org Name:DALMO OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARRABBA
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGER
Authorized Official - Phone:724-282-8533
Mailing Address - Street 1:330 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-4954
Mailing Address - Country:US
Mailing Address - Phone:724-282-8533
Mailing Address - Fax:724-282-9735
Practice Address - Street 1:330 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-4954
Practice Address - Country:US
Practice Address - Phone:724-282-8533
Practice Address - Fax:724-282-9735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6000001101156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA160592OtherCOLE VISION LOCATION #
PAPA42663OtherVBA PROVIDER #
PA1634738OtherHIGHMARK PROVIDER NUMBER
PA105365OtherDORAL LOCATION NUMBER
PA105365OtherDORAL LOCATION NUMBER