Basic Information
| Provider Information | |||||||||
| NPI: | 1174589733 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHESTER COUNTY OPTICIANS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 923 PAOLI PIKE | ||||||||
| Address2: | WEST GOSHEN SHOPPING CENTER | ||||||||
| City: | WEST CHESTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193804527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106928300 | ||||||||
| FaxNumber: | 6106926007 | ||||||||
| Practice Location | |||||||||
| Address1: | 923 PAOLI PIKE | ||||||||
| Address2: | WEST GOSHEN SHOPPING CENTER | ||||||||
| City: | WEST CHESTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193804527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106928300 | ||||||||
| FaxNumber: | 6106926007 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2006 | ||||||||
| LastUpdateDate: | 10/22/2013 | ||||||||
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| AuthorizedOfficialLastName: | STRATTON | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6106925019 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CHESTER COUNTY OPTICIANS INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332H00000X | Y | Suppliers | Eyewear Supplier (Equipment, not the service) |
ID Information
| ID | Type | State | Issuer | Description | PA923 | 01 | PA | VBA | OTHER | PW5019 | 01 | PA | DAVIS | OTHER | OP0462 | 01 | PA | EYEMED | OTHER |