Organization
FORMICA OPTICAL INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES A FORMICA (PRESIDENT)
(814) 255-2814
Entity
Organization
Contact information
Practice address
1751 LYTER DR, JOHNSTOWN, PA 15905-1207
(814) 255-2814
(814) 255-5890
Mailing address
1751 LYTER DR, JOHNSTOWN, PA 15905-1207
(814) 255-2814
(814) 255-5890
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0016286900002
—
PA
Enumeration date
10/19/2005
Last updated
01/14/2010
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