| Organization Name: | THE OPTICAL ROOM INC |
| NPI Number: | 1295810182 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOSEPH DOUGLAS CERVELLO (OWNER OPTICIAN) |
| Mailing Address: | 20 West Ave Brockport |
| State: | NY US |
| Postal Code: | 144201304 |
| Phone Number: | 5856375858 |
| Fax Number: | |
| NPI Enumeration Date: | 10/26/2006 |
| NPI Last Update Date: | 03/11/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BC3200X |
| License Number: | 003478 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Customized Equipment |
| Taxonomy Definition: | |