1992713184 NPI number — OPTOMETRIC CARE, INC

Table of content: (NPI 1992713184)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992713184 NPI number — OPTOMETRIC CARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPTOMETRIC CARE, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992713184
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2576 BRODHEAD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALIQUIPPA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15001-4380
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-378-8585
Provider Business Mailing Address Fax Number:
724-375-1574

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2576 BRODHEAD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALIQUIPPA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15001-4380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-378-8585
Provider Business Practice Location Address Fax Number:
724-375-1574
Provider Enumeration Date:
08/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MADRON
Authorized Official First Name:
CHRISTINE
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
724-378-8585

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OEG000668 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152W00000X , with the licence number: OEG001209 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: OEG000767 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: OEG000609 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: MD044348L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 030648 . This is a "HIGHMARK BLUE CROSS BLUE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 410022561 . This is a "PALMETTO GBA- RR MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 410021871 . This is a "PALMETTO GBA- RR MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 410049399 . This is a "PALMETTO GBA - RR MEDICAR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 71433 . This is a "AETNA USHC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: CK0439 . This is a "PALMETTO GBA-RR MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 990014792 . This is a "PALMETTO GBA- RR MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 00974193 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 137798 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 410019681 . This is a "PALMETTO GBA -RAILROADMED" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 580000485 . This is a "PALMETTO GBA-RR MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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