Provider Demographics
NPI:1992811210
Name:OPTICAL NEI INC
Entity type:Organization
Organization Name:OPTICAL NEI INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-342-3145
Mailing Address - Street 1:200 MIFFLIN AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-1982
Mailing Address - Country:US
Mailing Address - Phone:570-342-3145
Mailing Address - Fax:570-344-1309
Practice Address - Street 1:679 KIDDER ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-6908
Practice Address - Country:US
Practice Address - Phone:570-825-3491
Practice Address - Fax:570-825-5654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
26401OtherSPECTERA
OP1837OtherEYEMED
PA04582OtherVBA
PA296498OtherFEDERAL BS
PA287175OtherBLUE SHIELD
PA287175Other65 SPECIAL
PA287175OtherFEDERAL BS
51632OtherDAVIS
PA18503OtherBS MICHIGAN
PA04368OtherVBA
PA24783OtherGEISINGER
PA296498Other65 SPECIAL
PA05026OtherVBA
PA1018OtherGEISINGER VENDOR
OP1837OtherEYEMED
PA287175Other65 SPECIAL
=========OtherVSP
PA04582OtherVBA