NPIMap

Organization Active NPI

Boscovs Department Store LLC

Doing business as Boscov's Optical

  • Eyewear Supplier
  • St. Clairsville, OH
National Provider Identifier
1255257655
Registry record updated Jun 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
Legal business name
BOSCOVS DEPARTMENT STORE LLC
Doing business as
Boscov's Optical
Practice address
67800 Mall Rd
St. Clairsville, OH 43950
Phone
(740) 695-1457
NPI assigned
Jun 29, 2026
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michael Derenzo
Title
Director of Optical Services
Phone
(856) 759-9905

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X Primary

Addresses

Primary practice location

67800 Mall Rd
St. Clairsville, OH 43950

Mailing address

4500 Perkiomen Ave
Reading, PA 19606-3946
Phone (610) 779-2000

Other names 1

  • Boscov's Optical Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Boscovs Department Store LLC42 organizations share this tax ID, including this one

Other organizations with this tax ID 41

Organizations that report the same tax identification number in the National Provider Directory.

View all 41

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1782691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782691200000",
    "number": "1255257655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 PERKIOMEN AVE",
            "city": "READING",
            "state": "PA",
            "postal_code": "196063946",
            "telephone_number": "610-779-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "67800 MALL RD",
            "city": "ST. CLAIRSVILLE",
            "state": "OH",
            "postal_code": "43950",
            "telephone_number": "740-695-1457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOSCOVS DEPARTMENT STORE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-06-29",
        "last_updated": "2026-06-29",
        "certification_date": "2026-06-09",
        "status": "A",
        "authorized_official_last_name": "DERENZO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "DIRECTOR OF OPTICAL SERVICES",
        "authorized_official_telephone_number": "856-759-9905"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boscov's Optical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St. Clairsville, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.