1518998103 NPI number — MIDDLETOWN EYE CARE PA

Table of content: (NPI 1518998103)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518998103 NPI number — MIDDLETOWN EYE CARE PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDDLETOWN EYE CARE PA
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:
1518998103
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
228 DOVE RUN CENTRE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLETOWN
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19709-7971
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-378-8818
Provider Business Mailing Address Fax Number:
302-378-2371

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
228 DOVE RUN CENTRE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19709-7971
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-378-8818
Provider Business Practice Location Address Fax Number:
302-378-2371
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CLUFF
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
BESSIE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
302-378-8818

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  DE I3-1235 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00332068 . This is a "AMERIHEALTH PPO" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 05435504 . This is a "CIGNA" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 06083 . This is a "SPECTERA" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 000884645 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0671527000 . This is a "AMERIHEALTH HMO" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 39755 . This is a "DAVIS" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 2017754 . This is a "AETNA" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




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