1427126267 NPI number — VISIONCARE LASER CENTERS OF ERIE

Table of content: (NPI 1427126267)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427126267 NPI number — VISIONCARE LASER CENTERS OF ERIE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VISIONCARE LASER CENTERS OF ERIE
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:
SCHROECK OPTICAL FASHIONS
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:
1427126267
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1909 WEST 8TH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ERIE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16505-4936
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-454-7088
Provider Business Mailing Address Fax Number:
814-459-5189

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1909 WEST 8TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ERIE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16505-4936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-454-7088
Provider Business Practice Location Address Fax Number:
814-459-5189
Provider Enumeration Date:
12/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CANELLA
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
THOMAS
Authorized Official Title or Position:
GENERAL MANAGER
Authorized Official Telephone Number:
814-454-7088

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OB007924A , 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: 205697 . This is a "BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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