Provider Demographics
NPI:1154347813
Name:CENTRE OPTICAL SERVICES, INC.
Entity type:Organization
Organization Name:CENTRE OPTICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-238-5392
Mailing Address - Street 1:507 LOCUST LN
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-5419
Mailing Address - Country:US
Mailing Address - Phone:814-238-5392
Mailing Address - Fax:814-237-5663
Practice Address - Street 1:507 LOCUST LN
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-5419
Practice Address - Country:US
Practice Address - Phone:814-238-5392
Practice Address - Fax:814-237-5663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0545450001Medicare NSC