1417953928 NPI number — LEBANON EYECARE ASSOCIATES

Table of content: (NPI 1417953928)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417953928 NPI number — LEBANON EYECARE ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEBANON EYECARE ASSOCIATES
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:
1417953928
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2627 WEST CUMBERLAND STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEBANON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-272-3068
Provider Business Mailing Address Fax Number:
717-272-1682

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2627 WEST CUMBERLAND STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-272-3068
Provider Business Practice Location Address Fax Number:
717-272-1682
Provider Enumeration Date:
06/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
RITTLE
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
GENERAL MANAGER
Authorized Official Telephone Number:
717-272-3068

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2519696386 , 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: 1245490001 . This is a "HEALTHNOW (DMERC)" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PA6663 . This is a "EYEMED" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3000058 . This is a "KEYSTONE HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 396296 . This is a "NATIONAL VISION ADMIN." identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 396296 . This is a "CAPTIAL BLUE CROSS NVA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 396296 . This is a "PROVANTAGE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2075558 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 32735 . This is a "HEALTHGUARD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 4482 . This is a "GEISINGER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02448800 . This is a "NCAS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02448800 . This is a "CAPTIAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1245490001 . This is a "PALMETTO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: LE743579 . This is a "FEDERAL EMPLOYEE PROGRAM" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: LE743579 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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