Organization
FORMICA OPTICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES A FORMICA (OWNER)
(814) 443-6508
Entity
Organization
Contact information
Practice address
110 REVCO RD, SOMERSET, PA 15501-7726
(814) 443-6508
(814) 443-0590
Mailing address
110 REVCO RD, SOMERSET, PA 15501-7726
(814) 443-6508
(814) 443-0590
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0012176490001
—
PA
Enumeration date
10/19/2005
Last updated
08/22/2020
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