1902869688 NPI number — HUNTER FAMILY EYE CARE, LLC

Table of content: (NPI 1902869688)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902869688 NPI number — HUNTER FAMILY EYE CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUNTER FAMILY EYE CARE, LLC
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:
1902869688
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4286
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARRISBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17111-0286
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-540-0588
Provider Business Mailing Address Fax Number:
818-301-2626

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
698 SHREWSBURY COMMONS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHREWSBURY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17361-1617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-235-0788
Provider Business Practice Location Address Fax Number:
717-235-0349
Provider Enumeration Date:
04/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LIANG
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
717-540-0588

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OEG001652 , 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: 7882679 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2495622005 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1012775320002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: HU1725178 . This is a "HIGHMARK BLUESHEILD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 6463-9901 . This is a "CAREFIRST BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 51448 . This is a "DAVIS VISION" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: K7020001 . This is a "CAREFIRST BCBS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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