1215997879 NPI number — EYE CARE SPECIALISTS, P.C.

Table of content: (NPI 1215997879)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215997879 NPI number — EYE CARE SPECIALISTS, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYE CARE SPECIALISTS, P.C.
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:
1215997879
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
703 RUTTER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINGSTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18704-4801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-288-7405
Provider Business Mailing Address Fax Number:
570-288-7406

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
703 RUTTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18704-4801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-288-7405
Provider Business Practice Location Address Fax Number:
570-288-7406
Provider Enumeration Date:
03/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SZULBORSKI
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
GEORGE
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
570-288-7405

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0090282000 . This is a "BLUE SHIELD PERSONAL CHOI" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02297100 . This is a "CAPITAL BC KEYSTONE SENIO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1512852 . This is a "GATEWAY HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02297100 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02297100 . This is a "CAPITAL BC KEYSTONE BLUE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000139485 . This is a "UNISON MEDPLUS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1996 . This is a "GEISINGER GOLD HEALTH PLA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 20008501 . This is a "AMERIHEALTH MERCY HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0010897540025 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 181248 . This is a "FIRST PRIORITY LIFE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 181248 . This is a "FREEDOM BLUE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1996 . This is a "GEISINGER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 072304 . This is a "FIRST PRIORITY HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 700616 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 181248 . This is a "BLUE SHIELD OF PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 181248 . This is a "BLUE SHIELD VISION PLANS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 181248 . This is a "BLUE SHIELD FEDERAL EMPLO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 505963 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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