Basic Information
| Provider Information | |||||||||
| NPI: | 1710093133 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | USA OPTICAL INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2553 E MARKET ST | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174022403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177575632 | ||||||||
| FaxNumber: | 7178404462 | ||||||||
| Practice Location | |||||||||
| Address1: | 2553 E MARKET ST | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174022403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177575632 | ||||||||
| FaxNumber: | 7178404462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 10/16/2014 | ||||||||
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| AuthorizedOfficialLastName: | HOWELL | ||||||||
| AuthorizedOfficialFirstName: | REBEKAH | ||||||||
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| AuthorizedOfficialTitleorPosition: | INSURANCE | ||||||||
| AuthorizedOfficialTelephone: | 7177575632 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 156FC0801X | N | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Technician/Technologist | Contact Lens Fitter | 156FX1800X | N | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Technician/Technologist | Optician | 332H00000X | N | Suppliers | Eyewear Supplier (Equipment, not the service) | 152W00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 081338 | 01 | PA | MEDICARE PART B | OTHER | 1007366300005 | 05 | PA | MEDICAID |