1740366194 NPI number — DR. JULIE ELLEN LILLIE OD

Table of content: NATHAN KEEFER MD (NPI 1235981747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740366194 NPI number — DR. JULIE ELLEN LILLIE OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LILLIE
Provider First Name:
JULIE
Provider Middle Name:
ELLEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BEUERIDGE
Provider Other First Name:
JULIE
Provider Other Middle Name:
ELLEN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1740366194
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2576 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:
16505-4416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-833-1194
Provider Business Mailing Address Fax Number:
814-838-9530

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2576 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:
16505-4416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-833-1194
Provider Business Practice Location Address Fax Number:
814-838-9530
Provider Enumeration Date:
10/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  DEG000215 , 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: PA0215 . This is a "EYEMED" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0015585300004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3451 . This is a "UNISON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3451 . This is a "DAVIS VISION" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: WE1350395 . This is a "BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 393477 . This is a "NATIONAL VISION ADMIN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 53180 . This is a "DAVIS VISION" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 13008 . This is a "SPECTERA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PA7516 . This is a "VISION BENEFITS OF AMERIC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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