Provider Demographics
NPI:1285731877
Name:HAPPY VALLEY OPTICAL, INC
Entity type:Organization
Organization Name:HAPPY VALLEY OPTICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:M
Authorized Official - Last Name:DUTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-238-7281
Mailing Address - Street 1:208 S ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-4805
Mailing Address - Country:US
Mailing Address - Phone:814-238-7281
Mailing Address - Fax:814-234-5671
Practice Address - Street 1:208 S ALLEN ST
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-4805
Practice Address - Country:US
Practice Address - Phone:814-238-7281
Practice Address - Fax:814-234-5671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5518640001Medicare ID - Type Unspecified