1639127921 NPI number — EYE CARE FOR YOU INC

Table of content: (NPI 1639127921)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639127921 NPI number — EYE CARE FOR YOU INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYE CARE FOR YOU INC
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:
1639127921
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
972 MANOR AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEADOWBROOK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19046-1324
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-500-1578
Provider Business Mailing Address Fax Number:
215-572-6308

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2250 CHEMICAL RD
Provider Second Line Business Practice Location Address:
TARGET OPTICAL
Provider Business Practice Location Address City Name:
PLYMOUTH MEETING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19462-1716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-276-0045
Provider Business Practice Location Address Fax Number:
610-276-0047
Provider Enumeration Date:
05/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KOZARSKY
Authorized Official First Name:
TOD
Authorized Official Middle Name:
A
Authorized Official Title or Position:
0WNER
Authorized Official Telephone Number:
215-500-1578

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OET009021 , 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: 00862590 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 397170 . This is a "NATIONAL VISION ADM." identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50154 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 90463 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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