1558676312 NPI number — GRIFFITH EYE CENTER PC

Table of content: (NPI 1558676312)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558676312 NPI number — GRIFFITH EYE CENTER PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRIFFITH EYE CENTER 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:
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:
1558676312
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2640 W 38TH ST
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:
16506-4524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-835-8258
Provider Business Mailing Address Fax Number:
814-838-0104

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41 S LAKE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH EAST
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16428-1239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-835-8258
Provider Business Practice Location Address Fax Number:
814-838-0104
Provider Enumeration Date:
08/17/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GRIFFITH
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
814-835-8258

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , 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)