1700806916 NPI number — FAMILY EYE CARE PC

Table of content: (NPI 1700806916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700806916 NPI number — FAMILY EYE CARE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY EYE CARE PC
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:
1700806916
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5012 CARLISLE PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MECHANICSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-837-3790
Provider Business Mailing Address Fax Number:
717-901-6565

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5012 CARLISLE PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MECHANICSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-763-2020
Provider Business Practice Location Address Fax Number:
717-901-6565
Provider Enumeration Date:
07/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HENRY
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
508-837-3790

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OE007172T , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: OE007124T , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152W00000X , with the licence number: OEG001260 , 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: 0077805020002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".