1831343664 NPI number — YOUR FAMILY EYE DOCTORS, INC

Table of content: (NPI 1831343664)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831343664 NPI number — YOUR FAMILY EYE DOCTORS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YOUR FAMILY EYE DOCTORS, 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:
1831343664
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8775 NORWIN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
N HUNTINGDON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15642-2718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-864-7777
Provider Business Mailing Address Fax Number:
724-864-7779

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3520 ROUTE 130
Provider Second Line Business Practice Location Address:
2001
Provider Business Practice Location Address City Name:
IRWIN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15642-1438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-744-7000
Provider Business Practice Location Address Fax Number:
724-744-7001
Provider Enumeration Date:
11/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CAKANAC
Authorized Official First Name:
JUSTINE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
724-864-7777

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OEG000583 , 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: 704404 . This is a "HIGHMARK BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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