1982600136 NPI number — BERKS FAMILY EYECARE P C

Table of content: MR. JEFFERY ALLAN HAMILTON APRN (NPI 1962097428)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982600136 NPI number — BERKS FAMILY EYECARE P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BERKS FAMILY EYECARE 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:
1982600136
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
247 E PENN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WERNERSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19565-1613
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-678-7202
Provider Business Mailing Address Fax Number:
610-678-9866

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
247 E PENN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WERNERSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19565-1613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-678-7202
Provider Business Practice Location Address Fax Number:
610-678-9866
Provider Enumeration Date:
06/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
610-678-7202

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OEG000172 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152WL0500X , with the licence number: OEG000172 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 3761630 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 806T . This is a "GEISINGER" identifier . This identifiers is of the category "OTHER".
  • Identifier: DG1504 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001919333 . This is a "HIGHMARK BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02667300 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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