1154381606 NPI number — HORIZON EYE CARE GROUP, P.C.

Table of content: (NPI 1154381606)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154381606 NPI number — HORIZON EYE CARE GROUP, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HORIZON EYE CARE GROUP, 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:
6
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:
1154381606
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 WILSON ST
Provider Second Line Business Mailing Address:
STE 207
Provider Business Mailing Address City Name:
CARLISLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17013-3697
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-243-2300
Provider Business Mailing Address Fax Number:
717-258-0928

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 WILSON ST
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
CARLISLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17013-3697
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-243-2300
Provider Business Practice Location Address Fax Number:
717-258-0928
Provider Enumeration Date:
03/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PROCOPE
Authorized Official First Name:
JULIAN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT/ CEO
Authorized Official Telephone Number:
717-243-2300

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OEG001714 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: MD055564L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0775136 . This is a "KEYSTONE GROUP NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02362600 . This is a "CAPITAL BLUE CROSS GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2241668 . This is a "AETNA GROUP NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 85763 . This is a "HEALTH AMERICA GROUP #" identifier . This identifiers is of the category "OTHER".




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