Provider Demographics
NPI:1194787259
Name:SCHROECK OPTICAL FASHIONS
Entity type:Organization
Organization Name:SCHROECK OPTICAL FASHIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHROECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:8148-264-3039
Mailing Address - Street 1:3424 PEACH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2740
Mailing Address - Country:US
Mailing Address - Phone:814-864-3039
Mailing Address - Fax:814-864-3030
Practice Address - Street 1:3424 PEACH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2740
Practice Address - Country:US
Practice Address - Phone:814-864-3039
Practice Address - Fax:814-864-3030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASC285340OtherBLUE CROSS BLUE SHIELD
PASC285340OtherBLUE CROSS BLUE SHIELD