Provider Demographics
NPI:1063701332
Name:SLATE BELT OPTICAL & HEARING CENTER, LLC.
Entity type:Organization
Organization Name:SLATE BELT OPTICAL & HEARING CENTER, LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:BAYDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-642-0001
Mailing Address - Street 1:352 BLUE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:PA
Mailing Address - Zip Code:18013-1515
Mailing Address - Country:US
Mailing Address - Phone:610-588-5665
Mailing Address - Fax:610-588-3383
Practice Address - Street 1:352 BLUE VALLEY DR
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:PA
Practice Address - Zip Code:18013-1515
Practice Address - Country:US
Practice Address - Phone:610-588-5665
Practice Address - Fax:610-588-3383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies