1245438894 NPI number — HARRISBURG EYE CARE, P.C.

Table of content: (NPI 1245438894)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245438894 NPI number — HARRISBURG EYE CARE, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARRISBURG EYE CARE, 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:
1245438894
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 S CLIFF AVE #102
Provider Second Line Business Mailing Address:
PO BOX 298
Provider Business Mailing Address City Name:
HARRISBURG
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-213-2020
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 S CLIFF AVE
Provider Second Line Business Practice Location Address:
#102
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-213-2020
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BOER
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
605-213-2020

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  637 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9203752 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com