1457584617 NPI number — THE EYE CARE CONNECTION, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457584617 NPI number — THE EYE CARE CONNECTION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE EYE CARE CONNECTION, 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:
1457584617
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5351 LINCOLN HWY
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
GAP
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17527-9468
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-442-1300
Provider Business Mailing Address Fax Number:
717-442-1064

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5351 LINCOLN HWY
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
GAP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17527-9468
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-442-1300
Provider Business Practice Location Address Fax Number:
717-442-1064
Provider Enumeration Date:
09/03/2009

Additional Information

Authorized Official

Authorized Official Last Name:
GOGOLA
Authorized Official First Name:
GLORIA
Authorized Official Middle Name:
BERNADETTE
Authorized Official Title or Position:
OWNER/PRESIDENT/OPTOMETRIST
Authorized Official Telephone Number:
717-442-1300

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OEG000541 , 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: 2651259 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 930316 . This is a "EYEMED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 53792 . This is a "DAVIS VISION" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PA08206 . This is a "VBA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 381737 . This is a "BLUE CROSS/ BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 397049 . This is a "NVA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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