1134129372 NPI number — AC VISIONCARE,PC

Table of content: (NPI 1447336649)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134129372 NPI number — AC VISIONCARE,PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AC VISIONCARE,PC
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:
ADAMS CUMBERLAND VISION CARE
Provider Other Organization Name Type Code:
3
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:
1134129372
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3375 CARLISLE RD
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
GARDNERS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17324-9603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-677-9141
Provider Business Mailing Address Fax Number:
717-677-4360

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3375 CARLISLE RD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
GARDNERS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17324-9603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-677-9141
Provider Business Practice Location Address Fax Number:
717-677-4360
Provider Enumeration Date:
07/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
STOKEN
Authorized Official First Name:
DON
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OPTOMETRIST/OWNER
Authorized Official Telephone Number:
717-677-9141

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3555119 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 396183 . This is a "NATIONAL VISION ADMIN." identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50146 . This is a "GATEWAY,MEDPLUS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P00147871 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02745000 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1010879030001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: PA00782 . This is a "VISION BENEFITS OF AMER." identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001630574 . This is a "HIGHMARK BLUE SHEILD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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