Provider Demographics
NPI:1902808025
Name:NIX OPTICAL COMPANY
Entity Type:Organization
Organization Name:NIX OPTICAL COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:NIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-483-6527
Mailing Address - Street 1:PO BOX 6
Mailing Address - Street 2:216 LINCOLN AVENUE EXT
Mailing Address - City:CHARLEROI
Mailing Address - State:PA
Mailing Address - Zip Code:15022-0006
Mailing Address - Country:US
Mailing Address - Phone:724-483-6527
Mailing Address - Fax:724-483-6504
Practice Address - Street 1:216 LINCOLN AVENUE EXT
Practice Address - Street 2:
Practice Address - City:CHARLEROI
Practice Address - State:PA
Practice Address - Zip Code:15022-3080
Practice Address - Country:US
Practice Address - Phone:724-483-6527
Practice Address - Fax:724-483-6504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017267700001OtherMAID
PA0572870001Medicare ID - Type Unspecified