Provider Demographics
NPI:1720253321
Name:ELY OPTICIANS
Entity type:Organization
Organization Name:ELY OPTICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERIFIED OPTICIAN/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-688-1121
Mailing Address - Street 1:335 W LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-3904
Mailing Address - Country:US
Mailing Address - Phone:610-688-1121
Mailing Address - Fax:610-688-4554
Practice Address - Street 1:335 W LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-3904
Practice Address - Country:US
Practice Address - Phone:610-688-1121
Practice Address - Fax:610-688-4554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5542350001Medicare NSC