1144380601 NPI number — FAMILY EYE HEALTH CENTER P C

Table of content: (NPI 1144380601)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144380601 NPI number — FAMILY EYE HEALTH CENTER P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY EYE HEALTH CENTER P C
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:
1144380601
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRADFORD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16701-2004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-368-7090
Provider Business Mailing Address Fax Number:
814-368-5855

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRADFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16701-2004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-368-7090
Provider Business Practice Location Address Fax Number:
814-368-5855
Provider Enumeration Date:
12/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KOHLER
Authorized Official First Name:
VERA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
814-368-7090

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 3687090 . This is a "VSP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 15156 . This is a "SPECTERA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 073044001 . This is a "TRAVELERS MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 212025 . This is a "UPMC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3740 . This is a "ECPA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000131398 . This is a "BLUE CARD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 410018195 . This is a "RR MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000131398 . This is a "HIGHMARK BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000131398 . This is a "KEYSTONE BLUE WEST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0005752970001 . This is a "DPA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 390850 . This is a "NVA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7043 . This is a "VBA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000131398 . This is a "PREFERRED BLUE PPO WEST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0005752970001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 53929 . This is a "DAVIS VISION" identifier . This identifiers is of the category "OTHER".




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