1639127921 NPI number — EYE CARE FOR YOU 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 1639127921 NPI number — EYE CARE FOR YOU INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYE CARE FOR YOU 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:
1639127921
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
972 MANOR AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEADOWBROOK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19046-1324
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-500-1578
Provider Business Mailing Address Fax Number:
215-572-6308

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2250 CHEMICAL RD
Provider Second Line Business Practice Location Address:
TARGET OPTICAL
Provider Business Practice Location Address City Name:
PLYMOUTH MEETING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19462-1716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-276-0045
Provider Business Practice Location Address Fax Number:
610-276-0047
Provider Enumeration Date:
05/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KOZARSKY
Authorized Official First Name:
TOD
Authorized Official Middle Name:
A
Authorized Official Title or Position:
0WNER
Authorized Official Telephone Number:
215-500-1578

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OET009021 , 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: 00862590 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 397170 . This is a "NATIONAL VISION ADM." identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50154 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 90463 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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