1992902795 NPI number — J L EYE ASSOCIATES, PC

Table of content: (NPI 1992902795)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992902795 NPI number — J L EYE ASSOCIATES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
J L EYE ASSOCIATES, 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:
SKIPPACK EYECARE
Provider Other Organization Name Type Code:
3
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:
1992902795
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3990 ASHLAND DR
Provider Second Line Business Mailing Address:
46 PO BOX
Provider Business Mailing Address City Name:
SKIPPACK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19474-0046
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-410-5290
Provider Business Mailing Address Fax Number:
610-584-0314

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3990 ASHLAND DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SKIPPACK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19474-0046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-410-5290
Provider Business Practice Location Address Fax Number:
610-584-0314
Provider Enumeration Date:
06/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LIM
Authorized Official First Name:
JANE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
610-410-5290

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OEG000061 , 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: 1356407 . This is a "CLARITY BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 937240A . This is a "EYEMED" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7318153 . This is a "AETNA PROVIDER #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1029527140001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 410047467 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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