Basic Information
| Provider Information | |||||||||
| NPI: | 1801902226 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | USA OPTICAL INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 LOUCKS RD | ||||||||
| Address2: | SUITE 653 | ||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174084609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177648705 | ||||||||
| FaxNumber: | 7177675680 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 LOUCKS RD | ||||||||
| Address2: | SUITE 653 | ||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174084609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177648705 | ||||||||
| FaxNumber: | 7177675680 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 09/26/2014 | ||||||||
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| AuthorizedOfficialLastName: | KRABEL | ||||||||
| AuthorizedOfficialFirstName: | G | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | INSURANCE | ||||||||
| AuthorizedOfficialTelephone: | 7177648705 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 156FX1800X | N | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Technician/Technologist | Optician | 156FC0801X | N | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Technician/Technologist | Contact Lens Fitter | 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 | 1007366300004 | 05 | PA | MEDICAID |